Remark code N113 indicates coverage is limited to one initial visit per physician, group practice, or provider.
Remark code N113 indicates that reimbursement is limited to one initial visit per physician, group practice, or provider entity. This means that if multiple initial visits are billed, payment will only be made for the first encounter as defined by the payer's policy.
Common causes of code N113 are billing for multiple initial visits by the same physician, group practice, or provider for the same patient, submitting claims for a subsequent visit as an initial visit, or misunderstanding the payer's definition of an initial visit which leads to incorrect claim submissions.
Ways to mitigate code N113 include implementing a robust patient tracking system that records and verifies the number of initial visits per patient with each physician, group practice, or provider. Ensure that your scheduling and billing software can flag multiple initial visits for the same patient with the same provider. Additionally, staff training on the importance of accurately coding visits as initial or subsequent is crucial. Regular audits of billing records can also help identify and correct any patterns of incorrect initial visit claims before they are submitted.
The steps to address code N113 involve reviewing the patient's billing history to ensure that the claim in question is indeed the first initial visit billed under the specific physician, group practice, or provider. If it is the first initial visit and the claim was denied in error, gather the necessary documentation to support this and submit a corrected claim or an appeal to the payer with a detailed explanation and evidence of the error.
If the claim was correctly denied because an initial visit had already been billed, evaluate if the subsequent visit was billed incorrectly as an initial visit instead of a follow-up or established patient visit. If so, adjust the billing code to reflect the correct type of visit and resubmit the claim.
Additionally, ensure that your practice management system is updated to prevent duplicate initial visit billings and provide training to billing staff to recognize the appropriate circumstances under which an initial visit can be billed.
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