N918Remark Code (RARC)Active
N918 Remark Code - No Refund for Compounded Drugs
The N918 remark code indicates that no refund will be issued because CMS has excluded prescription drug event records when a compound code signifies it is for a compounded drug. This means the claim has been reviewed, and the payer has determined that the compounded drug does not warrant a refund as per CMS guidelines.
How It Relates to the Denial
The N918 remark code typically accompanies a claim adjustment reason code related to the denial or adjustment of compounded drugs under the Medicare Drug Price Negotiation Program. The presence of this remark reinforces the payer's decision regarding the billing of these specific drug records.
Common Scenarios
1A pharmacy submitted a claim for a compounded medication that included prescription drug event records, and the remittance response included an adjustment reason code related to the claim's denial.
→ In this case, the N918 remark code clarifies that the denial is due to CMS guidelines, which exclude certain records for compounded drugs, thus confirming the payer's stance on the refund.
2A provider billed for a series of compounded medications, and the remittance advice showed an adjustment for the claims, along with the N918 remark code.
→ Here, the N918 remark indicates that the compounded drug's nature led to the exclusion of the drug event records, reflecting CMS policy and justifying the adjustment made by the payer.
3A claim for a compounded drug was submitted with accompanying prescription drug event records, and the remittance indicated an adjustment with the N918 remark code.
→ In this scenario, the N918 remark code indicates that the payer has adhered to CMS regulations by excluding the records from consideration for a refund, thus supporting the adjustment made on the claim.
What to Do
- Review the accompanying claim adjustment reason code for details on the adjustment.
- Ensure that any future claims for compounded drugs comply with CMS guidelines regarding prescription drug event records.
- Communicate with the pharmacy or provider regarding the implications of the N918 remark on their billing practices.
What to Check
- The original claim submission to verify the compounded drug coding.
- The accompanying reason code for detailed information on the adjustment.
- CMS guidelines related to compounded drugs and prescription drug event records.