MA47Remark Code (RARC)Active
MA47 Remark Code - Medicare Opt-Out Explanation
The MA47 remark code indicates that the provider has opted out of Medicare, which means they have agreed with the patient not to submit claims for certain services to Medicare. As a result, the payer is unable to make a payment on the claim, and the patient is responsible for the costs associated with those services.
How It Relates to the Denial
The MA47 remark typically accompanies a claim adjustment reason code that reflects a denial of payment due to the provider's opt-out status. This combination signals that the claim cannot be processed for payment because the provider has chosen not to bill Medicare for the services rendered.
Common Scenarios
1A provider billed for a routine office visit after opting out of Medicare, and the claim was denied with an adjustment reason code indicating non-covered services.
→ The MA47 remark clarifies that the denial is due to the provider's agreement with the patient not to bill Medicare, confirming that the patient is financially responsible.
2A physical therapy session was billed to Medicare, but the provider had opted out and notified the patient beforehand, leading to a denial from the payer.
→ The presence of the MA47 remark reinforces that the claim cannot be paid because the provider opted out of Medicare, emphasizing the patient's responsibility for payment.
3A lab test was performed, and the claim was submitted to Medicare by a provider who had previously opted out, resulting in a denial with an accompanying reason code.
→ The MA47 remark indicates that the provider's opt-out agreement prevents the payer from reimbursing for the lab test, placing the financial responsibility on the patient.
What to Do
- Verify the patient's agreement with the provider regarding the opt-out status.
- Ensure that the patient understands they are responsible for payment due to the opt-out agreement.
- Document the opt-out agreement in the patient's records for future reference.
What to Check
- The patient's signed opt-out agreement with the provider.
- The claim adjustment reason code that accompanies the MA47 remark.
- The billing documentation to confirm services rendered were not billed to Medicare.