How To Fix Remark Code M960 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N762 means that the facility is not certified for Tomosynthesis (3-D) mammography. This code is used to indicate that the facility where the mammography was performed does not have the necessary certification to provide Tomosynthesis (3-D) mammography services. This can result in denial or adjustment of claims related to these specific services.

1. Description

Remark Code N762 indicates that the facility where the mammography was performed is not certified for Tomosynthesis (3-D) mammography. The official description states: ‘This facility is not certified for Tomosynthesis (3-D) mammography.’ Tomosynthesis, also known as 3-D mammography, is an advanced imaging technique that provides a more detailed view of breast tissue, allowing for improved detection of abnormalities. Certification ensures that the facility meets the necessary standards and qualifications to perform this specialized procedure.

2. Common Reasons

1. Lack of certification: The facility may not have pursued or obtained the required certification for Tomosynthesis (3-D) mammography.
2. Outdated certification: The facility may have had certification in the past but failed to renew or maintain it, resulting in the loss of certification.
3. Incorrect billing: The claim may have been submitted with incorrect billing codes or modifiers related to Tomosynthesis (3-D) mammography, leading to the denial or adjustment of the claim.
4. Non-compliance with certification requirements: The facility may have failed to meet the ongoing requirements and standards necessary to maintain certification for Tomosynthesis (3-D) mammography.

3. Next Steps

1. Contact the facility: Reach out to the facility where the mammography was performed to confirm the lack of certification for Tomosynthesis (3-D) mammography.
2. Seek alternative facilities: Identify other certified facilities that can provide Tomosynthesis (3-D) mammography services and refer patients accordingly.
3. Review billing and coding practices: Ensure that the correct billing codes and modifiers are used when submitting claims for Tomosynthesis (3-D) mammography to avoid future denials or adjustments.
4. Stay updated on certification requirements: Stay informed about the latest certification requirements and ensure compliance to maintain certification for Tomosynthesis (3-D) mammography.

4. How To Avoid It

1. Obtain proper certification: Facilities should pursue the necessary certification for Tomosynthesis (3-D) mammography to ensure compliance with industry standards and provide quality care.
2. Maintain certification: Facilities should stay updated on certification renewal requirements and ensure timely completion to avoid loss of certification.
3. Double-check billing codes and modifiers: Review billing and coding practices to ensure accurate submission of claims for Tomosynthesis (3-D) mammography.
4. Regularly review compliance: Conduct regular internal audits to ensure ongoing compliance with certification requirements for Tomosynthesis (3-D) mammography.

5. Example Cases

1. Case 1: A claim for Tomosynthesis (3-D) mammography is denied because the facility where the procedure was performed does not have the necessary certification. This highlights the importance of verifying certification before scheduling or performing the procedure.
2. Case 2: A claim adjustment occurs because the billing codes and modifiers for Tomosynthesis (3-D) mammography were incorrect, resulting in the need for resubmission with accurate information. This emphasizes the need for attention to detail in billing and coding practices.

Source: Remittance Advice Remark Codes