Remark code N413 is an alert indicating a service is covered twice in a benefit year, guiding billing adjustments.
Remark code N413 indicates that this service is permitted to be provided and billed a maximum of 2 times within a benefit year.
Common causes of code N413 are exceeding the allowed number of service instances within a benefit year, billing errors that mistakenly suggest a service was rendered more times than covered, or incorrect tracking of service dates that overlap into another benefit year.
Ways to mitigate code N413 include implementing a robust tracking system within your practice management software to monitor the frequency of specific services provided to each patient. Ensure that your scheduling and billing teams are aware of the benefit year limitations for services, and establish a pre-authorization process that verifies eligibility and service limits before appointments are confirmed. Additionally, educate your patients about their benefit limitations to manage expectations and prevent dissatisfaction. Regularly review payer contracts to stay updated on any changes to service limitations and communicate these updates to all relevant staff members.
The steps to address code N413 involve first verifying the patient's benefit year dates and confirming the number of times the service has already been provided and billed within that period. If the service has been provided fewer than 2 times, gather documentation to support this, including dates of service and any relevant medical records or prior authorization documents. Next, submit an appeal to the payer with this documentation, clearly stating that the service has not exceeded the allowed frequency for the benefit year. If the service has been provided 2 or more times, review the patient's coverage for possible exceptions based on medical necessity or check if an alternative billing code is applicable and permissible under the patient's plan. In cases where the service is genuinely over the limit, communicate with the patient about their options, which may include self-payment or exploring alternative treatments covered under their plan.
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