Remark code M135 indicates that the claim has been processed but there is an issue with the plan of treatment provided. Specifically, the plan of treatment is either missing, incomplete, or invalid, which needs to be addressed for proper claim adjudication.
Common causes of code M135 are:
1. The plan of treatment document is not attached to the claim submission, which is required to justify the medical necessity of the services provided.
2. The plan of treatment is incomplete, lacking essential details such as goals, duration, frequency, or specific procedures.
3. The plan of treatment is outdated, and the dates of service on the claim fall outside the authorized treatment period.
4. There are discrepancies between the plan of treatment and the services billed, indicating a potential mismatch or oversight.
5. The plan of treatment lacks the necessary signatures or credentials of the authorized healthcare provider who developed it.
6. The submitted plan of treatment does not comply with payer-specific guidelines or requirements, which can vary between insurance companies.
7. The plan of treatment is not updated to reflect changes in the patient's condition or treatment response, leading to inconsistencies with the billed services.
8. The electronic submission of the plan of treatment failed due to technical issues, resulting in the payer receiving an incomplete or corrupted document.
Ways to mitigate code M135 include ensuring that all treatment plans are fully documented, detailed, and updated in the patient's medical records before submitting claims. Regularly train staff on the importance of comprehensive documentation and establish a review process to verify that each plan of treatment includes necessary details such as goals, duration, frequency, and specific services to be provided. Utilize electronic health record (EHR) systems with built-in alerts to flag incomplete treatment plans and implement a checklist for providers to follow when creating or updating treatment plans. Conduct periodic audits to identify and address any recurring issues with treatment plan documentation.
The steps to address code M135 involve several key actions to resolve the issue of a missing, incomplete, or invalid plan of treatment. First, review the patient's medical records to ensure that a comprehensive and current plan of treatment was indeed created and documented by the healthcare provider. If the plan is missing, work with the provider to develop and document an appropriate plan of treatment.
If the plan is incomplete, identify the missing elements and collaborate with the provider to update the documentation accordingly. This may include specifying goals, interventions, duration, and frequency of treatment.
In the case of an invalid plan of treatment, assess the reasons for invalidation. It could be due to outdated information, non-adherence to clinical guidelines, or lack of necessary signatures. Address these issues by updating the treatment plan to meet the current standards and obtaining all required signatures.
Once the plan of treatment is corrected, resubmit the claim with the updated documentation. Ensure that all relevant coding and billing information aligns with the new or revised plan of treatment. Keep a record of the changes made and monitor the claim to confirm that it is processed successfully after resubmission.