Remark code N370 indicates billing surpasses the rental months authorized by the insurance, requiring review or adjustment.
Remark code N370 indicates that the billing submitted for rental equipment or services exceeds the number of months that have been covered or approved by the insurance payer.
Common causes of code N370 are:
1. Submitting claims for rental equipment beyond the maximum allowed rental period as specified by the payer's policy.
2. Incorrectly coding the rental period, leading to a claim for more months than have been authorized by the insurance provider.
3. Failing to update the claim to reflect the purchase of the rented equipment, if the equipment was bought out before the rental period covered by the payer ended.
4. Lack of communication or miscommunication between the healthcare provider and the payer regarding the approved rental period for the equipment.
5. Administrative errors in tracking the rental period or in the billing process, resulting in claims that exceed the agreed-upon or covered rental months.
6. Not adhering to specific payer guidelines that may limit the rental period for certain types of equipment, leading to claims that surpass these limitations.
Ways to mitigate code N370 include implementing a robust tracking system for rental equipment to monitor the duration of each rental period accurately. Ensure that billing staff are trained to cross-reference each invoice against the specific coverage limits for rental equipment as outlined by the payer. Utilize automated alerts to notify the billing team when the approved rental period is nearing its end, allowing for timely communication with both the payer and the patient about the next steps. Regularly review payer contracts and updates to stay informed about any changes in coverage for rental periods. Establish a clear process for extending rental periods, including obtaining necessary pre-approvals from payers before the current approval expires.
The steps to address code N370 involve a multi-faceted approach to ensure compliance with payer guidelines and to secure appropriate reimbursement for rental equipment. Initially, it's crucial to conduct a thorough review of the patient's file and the rental agreement to verify the duration of the rental period and compare it with the payer's coverage policy. If the billing exceeds the approved rental months due to an administrative error, correct the billing to reflect the accurate rental period and resubmit the claim.
In cases where the extended rental period was medically necessary, gather all relevant documentation, including physician's orders and medical records supporting the necessity for the extended rental. Prepare a detailed appeal letter explaining the medical necessity and include all supporting documentation. Submit this appeal to the payer, following their specific procedures for appeals.
Simultaneously, communicate with the patient to inform them of the billing discrepancy and the steps being taken to resolve it. This ensures transparency and maintains trust. If the appeal is denied or the payer maintains their original stance, consider discussing alternative payment arrangements with the patient, such as a payment plan for the balance not covered by insurance.
To prevent future occurrences of code N370, review and possibly revise internal processes for tracking rental periods against payer coverage limits. Implementing a system that alerts the billing department before exceeding the approved rental period can help avoid similar issues. Additionally, regular training for staff on payer policies and updates is essential to keep abreast of any changes in coverage that could affect billing for rental equipment.
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