Remark code M46 indicates that the claim has been processed with an issue related to the occurrence span codes: they are either missing, incomplete, or invalid. Occurrence span codes are used to provide additional information about events that relate to the billing period, and accurate codes are necessary for proper claim adjudication.
Common causes of code M46 are:
1. Incorrect or missing occurrence span codes entered on the claim form, which are necessary to report specific event dates that relate to the payment of the claim.
2. Failure to provide a complete set of applicable occurrence span codes, such as those required for reporting periods of time when a patient was not covered by the insurance policy.
3. Data entry errors where the occurrence span codes are either entered incorrectly or the dates associated with the codes are inaccurate.
4. Omission of required occurrence span codes that are necessary for processing claims under certain circumstances, like accident dates or dates of a qualifying stay for skilled nursing facility coverage.
5. Inconsistencies between the dates of service reported and the occurrence span codes, which may lead to confusion or rejection of the claim by the payer.
6. Lack of proper documentation to support the occurrence span codes entered, which can result in the payer being unable to verify the validity of the claim.
7. Use of outdated or invalid occurrence span codes that are no longer accepted by the payer, possibly due to changes in billing regulations or payer-specific guidelines.
Ways to mitigate code M46 include implementing a comprehensive review process to ensure that all required occurrence span codes are accurately captured and included on the claim form before submission. This can be achieved by:
- Training staff on the importance of occurrence span codes and the common reasons for errors.
- Utilizing automated claim scrubbing software that flags claims with missing or incomplete occurrence span codes.
- Establishing a double-check system where a second set of eyes reviews claims, specifically looking for and verifying occurrence span codes.
- Keeping up-to-date with payer-specific requirements regarding occurrence span codes to ensure compliance.
- Regularly auditing a sample of claims to identify and correct any patterns leading to the omission or inaccuracy of occurrence span codes.
The steps to address code M46 involve a thorough review of the claim to identify the missing, incomplete, or invalid occurrence span codes. Begin by cross-referencing the patient's medical records and the dates of service to ensure that all relevant events or time frames that should be captured by occurrence span codes are accurately documented. Update the claim with the correct occurrence span codes, ensuring that they are complete and formatted according to the appropriate coding guidelines. Before resubmission, double-check that all other claim information is accurate and that no additional errors are present. Once the corrections are made, resubmit the claim to the payer for processing.