How To Fix Remark Code M768 (RARC) | Common Reasons, Next Steps & How To Avoid It
Remark Code N566 means that the procedure code requires functional reporting. This code is used to alert healthcare providers and insurance companies that future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.
1. Description
Remark Code N566 indicates that the procedure code requires functional reporting. The official description states: ‘Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.’ This remark code serves as a reminder to healthcare providers to include the necessary information for accurate claim processing.
2. Common Reasons
- Failure to include functional reporting: Healthcare providers may overlook the requirement to include an applicable non-payable code and appropriate modifiers when submitting claims.
- Inadequate understanding of functional reporting requirements: Some healthcare providers may not be aware of the specific functional reporting requirements for certain procedure codes.
- Lack of documentation supporting functional reporting: Insufficient documentation may result in the omission of the necessary non-payable code and modifiers.
3. Next Steps
- Educate healthcare providers on functional reporting requirements: It is essential to ensure that healthcare providers are aware of the specific functional reporting requirements for each procedure code.
- Implement a system to prompt for non-payable codes and modifiers: Utilize electronic health record systems or billing software that can prompt healthcare providers to include the necessary non-payable codes and modifiers.
- Review documentation to ensure inclusion of functional reporting: Conduct regular audits to verify that the required non-payable codes and modifiers are being included in claims.
4. How To Avoid It
- Stay updated on functional reporting requirements: Regularly review and stay informed about any changes or updates to functional reporting requirements for procedure codes.
- Provide training and education to healthcare providers: Offer training sessions or educational materials to ensure that healthcare providers understand the importance of functional reporting and how to comply with the requirements.
- Implement documentation templates: Develop standardized documentation templates that include fields for non-payable codes and modifiers to facilitate accurate reporting.
5. Example Cases
- Case 1: A claim is denied because the necessary non-payable code and modifiers were not included for a procedure code requiring functional reporting, emphasizing the importance of compliance with reporting requirements.
- Case 2: A claim adjustment occurs due to incomplete documentation supporting functional reporting, highlighting the need for thorough and accurate documentation.
Source: Remittance Advice Remark Codes
