How To Fix Remark Code M267 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N43 means that the bed hold or leave days have exceeded the allowed limit. This code is used to indicate the reason for denial or adjustment of a claim related to bed hold or leave days. Understanding this code is crucial for medical coders to ensure accurate billing and reimbursement.

1. Description

Remark Code N43 indicates that the bed hold or leave days have exceeded the allowed limit. The official description states: ‘Bed hold or leave days exceeded.’ This remark code is used to notify healthcare providers and insurance companies that the number of days a patient is on bed hold or leave has surpassed the approved threshold.

2. Common Reasons

1. Extended hospital stay: One of the common reasons for Remark Code N43 is when a patient’s hospital stay is prolonged beyond the authorized bed hold or leave days.
2. Failure to obtain prior authorization: If the healthcare provider did not obtain prior authorization for the extended bed hold or leave days, it can result in the application of Remark Code N43.
3. Inadequate documentation: Insufficient documentation supporting the need for extended bed hold or leave days can lead to the application of this remark code.
4. Exceeding the maximum allowed bed hold or leave days: Each insurance plan or policy may have a specific limit on the number of bed hold or leave days allowed. If this limit is exceeded, Remark Code N43 may be applied.

3. Next Steps

1. Review the patient’s medical records: Thoroughly examine the patient’s medical records to determine the reason for the extended bed hold or leave days and ensure proper documentation is available.
2. Verify prior authorization: Check if the healthcare provider obtained prior authorization for the extended bed hold or leave days. If not, take the necessary steps to obtain the required authorization.
3. Communicate with the insurance company: Contact the insurance company to discuss the situation and provide any additional information or documentation required to support the extended bed hold or leave days.
4. Appeal the denial or adjustment: If the claim is denied or adjusted due to Remark Code N43, consider filing an appeal with the insurance company. Provide all relevant information and documentation to support the medical necessity of the extended bed hold or leave days.

4. How To Avoid It

1. Obtain prior authorization: Ensure that the healthcare provider obtains prior authorization for any extended bed hold or leave days to avoid the application of Remark Code N43.
2. Document medical necessity: Maintain detailed and accurate documentation supporting the need for extended bed hold or leave days. Include relevant medical records, physician orders, and any other supporting documentation.
3. Monitor bed hold or leave days: Regularly review the number of bed hold or leave days utilized by each patient to ensure they do not exceed the maximum allowed limit.
4. Communicate with the insurance company: Establish open lines of communication with the insurance company to address any questions or concerns regarding bed hold or leave days.

5. Example Cases

1. Case 1: A claim for extended bed hold days is denied because the healthcare provider failed to obtain prior authorization, highlighting the importance of obtaining proper authorization.
2. Case 2: A claim adjustment occurs due to inadequate documentation supporting the medical necessity of extended leave days, emphasizing the need for thorough and accurate documentation.

Source: Remittance Advice Remark Codes