How To Fix Remark Code M570 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N362 means that the number of Days or Units of Service exceeds the acceptable maximum set by the healthcare provider or insurance company. This code is used to indicate the reason for denial or adjustment of a claim when the services provided exceed the predetermined limit.

1. Description

Remark Code N362 indicates that the number of Days or Units of Service provided exceeds the acceptable maximum set by the healthcare provider or insurance company. The official description states: ‘The number of Days or Units of Service exceeds our acceptable maximum.’ This remark code is used to highlight instances where the services rendered go beyond the predetermined limit, leading to claim denials or adjustments.

2. Common Reasons

1. Insufficient pre-authorization: In some cases, the healthcare provider may not have obtained the necessary pre-authorization for the extended number of Days or Units of Service, resulting in claim denials.
2. Exceeding coverage limits: Insurance policies often have specific limits on the number of Days or Units of Service covered within a given timeframe. If the services provided exceed these limits, the claim may be adjusted or denied.
3. Incorrect coding: Errors in coding can lead to the incorrect calculation of Days or Units of Service, resulting in claims that exceed the acceptable maximum.
4. Lack of medical necessity: If the healthcare provider cannot justify the medical necessity for the extended number of Days or Units of Service, the claim may be denied or adjusted.

3. Next Steps

1. Review the pre-authorization process: Ensure that all necessary pre-authorization requirements are met before providing services that may exceed the acceptable maximum.
2. Verify coverage limits: Familiarize yourself with the coverage limits outlined in the patient’s insurance policy to avoid exceeding them.
3. Double-check coding accuracy: Thoroughly review the coding process to ensure accurate calculation of Days or Units of Service.
4. Document medical necessity: Provide detailed documentation justifying the medical necessity for the extended number of Days or Units of Service.

4. How To Avoid It

1. Obtain proper pre-authorization: Ensure that all necessary pre-authorization is obtained before providing services that may exceed the acceptable maximum.
2. Monitor coverage limits: Regularly review the coverage limits outlined in the patient’s insurance policy to avoid exceeding them.
3. Ensure accurate coding: Implement robust coding processes and conduct regular audits to minimize coding errors.
4. Document medical necessity: Thoroughly document the medical necessity for the extended number of Days or Units of Service to support the claim.

5. Example Cases

1. Case 1: A claim is denied because the number of Days or Units of Service provided exceeds the acceptable maximum outlined in the insurance policy, emphasizing the importance of adhering to coverage limits.
2. Case 2: A claim adjustment occurs due to coding errors that resulted in an incorrect calculation of Days or Units of Service, highlighting the need for accurate coding practices.

Source: Remittance Advice Remark Codes