How To Fix Remark Code M560 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N351 means that the service date falls outside of the approved treatment plan service dates. This code is used to indicate that the service provided was not within the specified timeframe outlined in the approved treatment plan. Healthcare providers and insurance companies utilize this code to explain the reason for denial or adjustment of a claim related to services provided outside of the approved treatment plan.

1. Description

Remark Code N351 indicates that the service date falls outside of the approved treatment plan service dates. The official description states: ‘Service date outside of the approved treatment plan service dates.’ This remark code is crucial in highlighting the importance of adhering to the specified timeframe outlined in the approved treatment plan. It ensures that services are provided within the appropriate timeframe for effective treatment and accurate billing.

2. Common Reasons

1. Service provided before the approved treatment plan start date: In some cases, healthcare providers may initiate services before the approved treatment plan officially begins. This can result in claim denials or adjustments.
2. Service provided after the approved treatment plan end date: Similarly, if services are provided after the approved treatment plan has ended, it may lead to claim denials or adjustments.
3. Service provided on dates not included in the approved treatment plan: The approved treatment plan specifies the dates on which services should be provided. If services are rendered on dates outside of this plan, it can result in claim denials or adjustments.
4. Service provided without proper authorization: If services are provided without the necessary authorization or approval, it can lead to claim denials or adjustments.

3. Next Steps

1. Review the approved treatment plan: Carefully examine the approved treatment plan to ensure that the service dates fall within the specified timeframe.
2. Contact the healthcare provider: If the service date falls outside of the approved treatment plan, reach out to the healthcare provider to discuss the discrepancy and determine the appropriate course of action.
3. Obtain necessary authorization: If the service was provided without proper authorization, work with the healthcare provider to obtain the required approval to avoid claim denials or adjustments in the future.

4. How To Avoid It

1. Adhere to the approved treatment plan: Ensure that services are provided within the specified timeframe outlined in the approved treatment plan.
2. Communicate with the healthcare provider: Maintain open lines of communication with the healthcare provider to ensure that services are scheduled and provided according to the approved treatment plan.
3. Obtain proper authorization: Ensure that all services are authorized and approved before they are rendered to avoid claim denials or adjustments.

5. Example Cases

1. Case 1: A claim for physical therapy services is denied because the service date falls outside of the approved treatment plan service dates, emphasizing the importance of adhering to the specified timeframe.
2. Case 2: A claim adjustment occurs because the service was provided without proper authorization, highlighting the need for obtaining the necessary approval before rendering services.

Source: Remittance Advice Remark Codes