Remark code M31 indicates that the claim has been denied or payment is being withheld because the required radiology report is missing from the documentation submitted. To resolve this issue, the healthcare provider must provide the missing radiology report to ensure proper claim adjudication.
Common causes of code M31 are typically related to the administrative processes within a healthcare provider's office or the interaction with the radiology department. These may include:
1. The radiology report was not attached to the claim before submission to the payer.
2. The report was completed but not properly filed or indexed in the patient's electronic health record (EHR), leading to it not being found during the billing process.
3. There was a delay in the radiology department's transcription process, causing the report to be unavailable when the claim was processed.
4. Technical issues, such as problems with the interface between the radiology information system (RIS) and the EHR or billing software, may have prevented the report from being transmitted or received.
5. Human error, such as oversight or miscommunication between the radiology department and the billing department, could result in the report not being included with the claim.
6. The radiology service may have been performed, but the report was not finalized by the radiologist due to pending additional information or clarification.
7. The claim was submitted before the radiology report was signed off by the radiologist, which is often a requirement for claim adjudication.
Addressing these issues typically involves establishing more robust communication and documentation workflows between radiology departments and billing personnel, ensuring timely completion and approval of radiology reports, and implementing checks within the RCM process to verify that all necessary documentation accompanies the claim before submission.
Ways to mitigate code M31 include implementing a robust documentation process that ensures all radiology reports are attached to the corresponding claims before submission. Establish a checklist for billing staff to verify that each radiology service billed has an accompanying report. Utilize electronic health record (EHR) systems with integrated imaging report features to automatically link radiology reports to patient accounts and claims. Train radiology and billing department staff on the importance of timely report finalization and submission. Regularly audit radiology claims to identify and address any recurring issues with missing reports.
The steps to address code M31 involve first confirming whether the radiology report was completed and, if so, ensuring that it is properly attached to the claim. If the report is missing, contact the radiology department to obtain the necessary documentation. Once the report is secured, resubmit the claim with the report attached. Additionally, review your process for attaching reports to prevent this issue from recurring in future claims.