M109Remark Code (RARC)Active
M109 Remark Code - Bundled Payment for Teleconsultation
The M109 remark code indicates that the payer has issued a bundled payment specifically for a teleconsultation service. It also specifies that 25 percent of that bundled payment must be forwarded to the referring practitioner, indicating a requirement for revenue sharing in this context.
How It Relates to the Denial
The M109 remark code typically accompanies a claim adjustment reason code that describes the bundled payment adjustment. This combination signals to the biller that there are additional financial responsibilities tied to the teleconsultation payment.
Common Scenarios
1A provider submitted a claim for a teleconsultation service and received a remittance advising of a bundled payment adjustment.
→ The M109 remark code informs the biller that a portion of the teleconsultation payment is designated for the referring practitioner, necessitating a reduction in the provider's expected revenue.
2A billing office processes a claim for a patient referred for a teleconsultation and receives an 835 with a bundled payment notice.
→ In this case, the M109 remark code serves as a reminder that 25 percent of the teleconsultation payment must be sent to the referring practitioner based on the payer's policy.
3After submitting a teleconsultation claim, the billing team notices a remittance with an adjustment stating a bundled payment has been made.
→ The appearance of the M109 remark code means the provider must account for the required 25 percent transfer to the referring practitioner in their financial records.
What to Do
- Calculate 25 percent of the teleconsultation payment received from the payer.
- Prepare to forward the calculated amount to the referring practitioner as required by the payer's policy.
- Ensure that this payment is documented in the provider's financial records for compliance.
What to Check
- The remittance advice for the original claim adjustment reason code that accompanies M109.
- The payment details for the teleconsultation to verify the total amount received.
- Any contractual agreements with the referring practitioner regarding payment splits for teleconsultations.