How To Fix Remark Code M372 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N156 means that the patient is responsible for the difference between the approved treatment and the elective treatment. This code serves as an alert to healthcare providers and insurance companies, indicating that the patient will be responsible for any additional costs incurred due to choosing elective treatment over the approved treatment.

1. Description

Remark Code N156 alerts healthcare providers and insurance companies that the patient is responsible for the difference between the approved treatment and the elective treatment. The official description states: ‘The patient is responsible for the difference between the approved treatment and the elective treatment.’ This code is used to indicate that the patient has chosen a treatment option that is not covered by their insurance plan or is considered elective, resulting in additional costs that they will need to pay out of pocket.

2. Common Reasons

1. Choosing elective treatment: One of the most common reasons for Remark Code N156 is when a patient decides to undergo a treatment that is not medically necessary or not covered by their insurance plan. This could include cosmetic procedures or alternative therapies that are not deemed essential for their condition.
2. Insurance plan limitations: Some insurance plans have specific limitations on coverage for certain treatments or procedures. If a patient chooses a treatment option that exceeds the coverage limits of their plan, they may be responsible for the difference in cost.
3. Out-of-network providers: If a patient chooses to receive treatment from a provider who is not in their insurance plan’s network, they may be responsible for a greater portion of the treatment cost. This can result in Remark Code N156 being applied to the claim.

3. Next Steps

1. Inform the patient: It is important to communicate with the patient and explain that they will be responsible for the additional costs associated with their chosen elective treatment. This can help manage their expectations and avoid any surprises when it comes to billing.
2. Provide cost estimates: Offer the patient a detailed breakdown of the costs they will be responsible for, including any deductibles, co-pays, or out-of-pocket expenses. This transparency can help them make informed decisions about their treatment options.
3. Explore alternative options: If the patient is concerned about the financial implications of their chosen elective treatment, discuss alternative options that may be covered by their insurance plan or offer more affordable alternatives.

4. How To Avoid It

1. Review insurance coverage: Before undergoing any treatment, patients should carefully review their insurance plan to understand what is covered and what is not. This can help them make informed decisions and avoid unexpected costs.
2. Consult with the insurance provider: If a patient is considering elective treatment, they should reach out to their insurance provider to confirm coverage and understand any potential out-of-pocket expenses. This can help them make an informed decision about their treatment options.
3. Consider in-network providers: Choosing healthcare providers within the patient’s insurance plan’s network can help minimize out-of-pocket expenses. In-network providers have negotiated rates with the insurance company, resulting in lower costs for the patient.

5. Example Cases

1. Case 1: A patient chooses to undergo a cosmetic procedure that is not covered by their insurance plan. As a result, Remark Code N156 is applied, and the patient is responsible for the full cost of the procedure.
2. Case 2: A patient opts for an alternative therapy for their condition, which is not considered medically necessary by their insurance plan. Remark Code N156 is applied, and the patient is responsible for the additional costs associated with the elective treatment.

Source: Remittance Advice Remark Codes