How To Fix Remark Code M620 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N413 means that a specific service is allowed only twice in a benefit year. This code is used to indicate the reason for denial or adjustment of a claim related to this particular service. Understanding the description and common reasons for this code can help medical coders navigate the claims process more effectively.

1. Description

Remark Code N413 indicates that a particular service is allowed only two times within a benefit year. The official description states: ‘This service is allowed 2 times in a benefit year.’ This limitation is put in place to manage healthcare costs and ensure appropriate utilization of services.

2. Common Reasons

1. Exceeded maximum allowable limit: The most common reason for Remark Code N413 is that the service has already been provided twice within the benefit year. This could be due to a lack of awareness of the limit or a failure to track the number of times the service has been utilized.
2. Incorrect billing: Another reason for this code may be incorrect billing, where the service is mistakenly billed more than twice within the benefit year. This could be a result of coding errors or a lack of understanding of the specific billing guidelines for the service.
3. Service not medically necessary: In some cases, the service may be denied or adjusted because it is deemed not medically necessary. This determination is typically made based on established medical guidelines and the individual patient’s condition.

3. Next Steps

1. Review the benefit year: Determine the start and end dates of the benefit year to understand the timeframe within which the service is allowed.
2. Check the number of times the service has been provided: Review the patient’s medical records and billing history to determine if the service has already been provided twice within the benefit year.
3. Verify medical necessity: If the service has not been provided twice, ensure that it is medically necessary and supported by appropriate documentation.
4. Correct any billing errors: If the service has been billed incorrectly, make the necessary corrections and resubmit the claim with accurate information.

4. How To Avoid It

1. Track the number of times the service is provided: Implement a system to track the number of times the service has been provided within the benefit year to avoid exceeding the allowable limit.
2. Stay updated on billing guidelines: Regularly review and stay updated on the specific billing guidelines for the service to ensure accurate and compliant billing.
3. Document medical necessity: Ensure that the service is medically necessary and supported by appropriate documentation to avoid denials or adjustments.

5. Example Cases

1. Case 1: A claim for the specific service is denied because it has already been provided twice within the benefit year, highlighting the importance of tracking the number of times the service is utilized.
2. Case 2: A claim adjustment occurs because the service was billed incorrectly, exceeding the allowable limit of two times within the benefit year, emphasizing the need for accurate billing practices.

Source: Remittance Advice Remark Codes