Remark code N673 indicates reimbursement is based on outpatient per diem, factor, or fee schedule amount, affecting payment calculations.
Remark code N673 indicates that the reimbursement amount has been determined based on an outpatient per diem rate or an outpatient factor, and/or according to a specific fee schedule amount.
Common causes of code N673 are incorrect billing of services that should be inpatient as outpatient, errors in the application of the outpatient per diem rates, inaccuracies in the calculation of the outpatient factor, and mistakes in applying the correct fee schedule amount. Additionally, this code may be triggered by discrepancies in the documentation supporting the billed services or failure to adhere to payer-specific guidelines for outpatient billing.
Ways to mitigate code N673 include implementing a comprehensive review process for all outpatient billing to ensure accuracy in the initial coding and billing stages. This involves training staff on the specific requirements and calculations for outpatient per diem rates, factor-based reimbursements, and fee schedule amounts. Utilize advanced billing software that automatically updates and applies the most current reimbursement structures and rates to prevent outdated or incorrect billing. Regularly audit outpatient billing practices to identify and correct discrepancies before claims submission. Establishing a clear communication channel with payers can also help clarify any specific documentation or billing requirements they may have, reducing the likelihood of receiving this code. Additionally, developing a robust denial management strategy that includes analyzing and addressing the root causes of denials related to outpatient reimbursement calculations can prevent future occurrences of this code.
The steps to address code N673 involve a multi-faceted approach to ensure accurate reimbursement. First, review the patient's service details against the outpatient per diem rates or the applicable outpatient factor and/or fee schedule amount to verify correctness. If discrepancies are found, prepare and submit a detailed appeal to the payer, including documentation that supports the claim for a higher reimbursement rate, such as medical records or a detailed breakdown of services provided.
Next, analyze your billing process to identify any potential errors in how outpatient services are coded and billed. This may involve training or retraining staff on the correct application of outpatient per diem rates, factors, and fee schedules. Additionally, consider implementing or enhancing software solutions that automatically flag claims that do not align with expected reimbursement amounts based on the services provided, facilitating early detection and correction of billing errors.
Finally, engage in regular communication with payers to stay updated on any changes to outpatient reimbursement policies and rates. This proactive approach can help prevent future occurrences of code N673 by ensuring that billing practices are aligned with current payer requirements and expectations.
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