Instructions for Use of Informational Remittance Advice Remark Code Alert on Laboratory Service Remittance Advices – (CR) Number: 11369

Under the CLFS final rule, reporting entities must report to the Centers for Medicare & Medicaid Services (CMS) certain private payor rate information (applicable information) for their component applicable laboratories. The implementation of PAMA required Medicare to pay the weighted median of private payor rates for each separate Healthcare Common Procedure Coding System (HCPCS) code. Laboratories, including an independent laboratory, a physician office laboratory, or a hospital outreach laboratory, that meet the definition of an applicable laboratory, must report information including laboratory test HCPCS codes, associated private payor rates, and volume data according to the below timeframes, generally every 3 years.

• January-June 2019: Collect data

• July-December 2019: Analyze data

• January-March 2020: Report data

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructs health plans to be able to conduct standard electronic transactions adopted under HIPAA using valid standard codes. Medicare policy states that Claim Adjustment Reason Codes (CARCs) and RARCs, as appropriate, which provide either supplemental explanation for a monetary adjustment or policy information that generally applies to the monetary adjustment, are required in the remittance advice and coordination of benefits transactions.

To assist in reminding laboratories of their reporting obligations, the following new alert RARC code will appear on remittances:

• N817: ALERT-Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 – March 31, 2020.

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11369.pdf