N807Remark Code (RARC)Active
N807 Remark Code - MIPS Payment Adjustment
The N807 remark code indicates that the payment adjustment you see is due to the Merit-based Incentive Payment System (MIPS). This means the payer has adjusted the payment based on performance measures associated with MIPS, which is part of the Quality Payment Program.
How It Relates to the Denial
The N807 remark typically accompanies a reason code that explains the adjustment made to a claim payment. Together, these codes signal that the adjustment is related to quality performance metrics under the MIPS framework.
Common Scenarios
1A claim for a primary care service was submitted and the remittance shows a reduction in payment amount.
→ The N807 remark code indicates that this reduction is due to MIPS performance metrics that were assessed for the provider, impacting the payment.
2A specialty service claim was processed, and the payment was adjusted down with a note referencing MIPS.
→ The presence of the N807 remark code suggests that the adjustment reflects the provider's MIPS performance, affecting the reimbursement received.
3A facility's claim for outpatient services received a payment adjustment, noted with the N807 remark on the remittance advice.
→ This remark code signifies that the adjustment correlates with MIPS criteria, which are used to evaluate and adjust payments based on quality of care.
What to Do
- Review the reason code that accompanies the N807 remark for details on the specific adjustment reason.
- Ensure that any MIPS performance measures relevant to the services billed are documented and up-to-date.
- If applicable, appeal the adjustment by providing evidence of performance metrics that meet MIPS standards.
What to Check
- The claim adjustment reason code that accompanies the N807 remark for additional context on the adjustment.
- Provider performance data related to MIPS for the period in question.
- Any documentation regarding MIPS requirements that may affect the claim adjustment.