Remark code N663 is an adjustment notice indicating a payment change due to a pre-negotiated agreement.
Remark code N663 indicates that the payment adjustment has been made based on a previously agreed-upon amount between the payer and the provider or another relevant party.
Common causes of code N663 (Adjusted based on an agreed amount) are discrepancies between the billed charges and the contracted or negotiated rates agreed upon between the healthcare provider and the insurance payer, incorrect billing of services that do not match the terms of the contract, or the application of a contractual adjustment based on specific terms outlined in the provider agreement. This code may also be used when there is a mutual agreement between the provider and payer to adjust the payment for a particular service, which could be due to a variety of reasons such as billing errors, negotiated settlements of disputed claims, or adjustments related to bundled payments or value-based care agreements.
Ways to mitigate code N663 include implementing a robust contract management system that keeps track of payer agreements and their specific billing requirements. Regularly training billing staff on the nuances of payer contracts can also help ensure that claims are submitted according to the agreed terms. Additionally, conducting periodic audits of billed versus paid amounts can help identify discrepancies early, allowing for timely adjustments and resubmissions if necessary. Establishing clear communication channels with payers to discuss and resolve any ambiguities in contract terms or payment amounts can further prevent this code from arising.
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The steps to address code N663 involve a multi-faceted approach to ensure that the adjustment made based on an agreed amount is correctly applied and reconciled within your healthcare revenue cycle management system. Initially, review the contract or agreement between your healthcare facility and the payer to confirm the specifics of the agreed amount. This involves ensuring that the services provided match the services outlined in the agreement and that the agreed amount is accurately reflected in the billing and claims processing system.
Next, audit the patient's account to verify that the adjustment has been applied correctly. This includes checking that the adjustment aligns with the contractual agreement and that no errors were made in the entry of the adjustment into the system. If discrepancies are found, prepare and submit a detailed adjustment request to the payer, including all necessary documentation to support the correction.
Additionally, communicate with the billing and coding team to ensure they are aware of the specifics of the agreement related to code N663 adjustments. This can help prevent future discrepancies and ensure that claims are submitted correctly the first time.
If the adjustment was made in error or without proper authorization, gather all relevant documentation, including the original claim, the contract or agreement specifying the agreed amount, and any correspondence with the payer regarding the adjustment. Use this documentation to contest the adjustment with the payer, providing a clear and concise explanation of the error and the correct amount that should have been billed.
Finally, monitor the resolution of the adjustment closely, following up with the payer as necessary to ensure that the agreed amount is correctly applied to the patient's account. Keep detailed records of all communications and actions taken to resolve the adjustment, as this documentation can be invaluable in case of disputes or for future reference.
By taking these steps, healthcare providers can effectively address code N663 adjustments, ensuring that they are accurately applied and that the revenue cycle is not negatively impacted by discrepancies or errors in agreed amounts.
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