CMS reports some claims are appearing without N365 Remark Code

Medicare claims use remark code N365 to indicate that your PQRS and E-Rx submissions have been received.  Some of our clients report that this remark code has been missing recently.   It is important that you know how to fix this or use alternate methods to look for acceptance of your PQRS and E-Rx submissions.

CMS, in a release on June 27, 2013, stated:

…  CMS is aware the Remittance Advice (RA)/Explanation of Benefits (EOBs) may not be displaying the N365 remark … for claims processed April 2013 through July 2013. The N365 remark code will reappear again starting for claims that are processed in July 2013 …  (Link here, then see page 11)

 CMS also notes in the release above:

 What should I do if I don’t see the N365 Remark Code?

The N365 remark code on the RA/EOB is an indication that the QDC is associated with current program year PQRS and/or eRx Incentive Program specifications, but does not confirm whether the QDC was accurately reported per program requirements. If the QDC $0.00 line item shows on the RA, but without the N365, it is possible the QDC is not within current program year specifications. It is also possible that the N365 is simply missing due to reporting using the $0.00 line item. All submitted QDCs on fully processed claims are forwarded to the NCH for analysis by the PQRS and/or eRx programs, so providers will first want to be sure they do see the QDC line item on the RA/EOB, regardless of whether the N365 appears…

 Importantly, CMS adds:

 If there is no QDC line item, it is possible that the provider’s claims software has stripped any $0.00 line items, and this will need to be corrected, either within the software, or by adding a $0.01 charge rather than $0.00.

 Adding the $0.01 charge to the QDC line item will help generate the N365 remark code, which will indicate whether the QDC is current. Providers may work with their vendors/billing systems/clearing houses to determine whether the option to submit a $0.00 or $0.01 charge for QDC line items will work best for their practice.

 As a result of the above, you should note:

            1)  So far, only claims between April and July 2013 may be affected.

            2)  You can retrieve the information in most cases as noted above.

            3)  Adding $0.01 to the code on a claim will generate the N365 remark code.

            4)  The N365 remark code should re-appear on claims in July 2013.

 If there are any questions, please contact us via phone or web at www.corcoranccg.com.