Remark code M71 indicates that the total payment for the claim has been reduced because there is an overlap of tests billed. This suggests that some of the diagnostic tests or procedures included in the claim have been identified as duplicates or as having been performed during the same time period, which typically is not allowable for separate reimbursement. The payer has adjusted the payment accordingly to reflect this overlap. Healthcare providers should review the claim to verify the accuracy of the test dates and services billed to address any potential billing errors or to provide additional clarification if necessary.
Common causes of code M71 are:
1. Duplicate Billing: Submitting multiple claims for the same diagnostic test or procedure for the same patient on the same date of service, which may occur due to clerical errors or misunderstanding of billing procedures.
2. Overlapping Services: Billing for tests that are considered part of a larger panel or comprehensive service, where individual tests should not be billed separately.
3. Lack of Coordination: When multiple providers are involved in a patient's care, there may be a lack of communication, leading to both providers billing for the same tests.
4. Incorrect Coding: Using the wrong procedure codes that may inadvertently suggest duplicate or overlapping services when the tests were actually distinct and separately billable.
5. Automated System Errors: Electronic health record (EHR) systems or billing software may automatically generate claims for tests without recognizing that they overlap with other billed services.
6. Insufficient Documentation: Failing to provide adequate documentation to support the medical necessity of each test, leading payers to assume that the tests are redundant.
7. Payer-Specific Billing Guidelines: Not adhering to a particular payer's billing guidelines, which may have specific rules about how certain tests should be billed in relation to others.
Addressing these issues requires careful attention to detail in the billing process, clear communication among healthcare providers, and a thorough understanding of payer billing guidelines to ensure that each test or procedure is billed correctly and justifiably.
Ways to mitigate code M71 include implementing a robust charge capture system that flags duplicate test orders before they are submitted for billing. Staff training on proper coding practices and the use of order entry protocols that require justification for repeat tests within a certain time frame can also help prevent this issue. Regular audits of billing data to identify patterns of overlapping tests can lead to process improvements that reduce the likelihood of this code being applied. Additionally, investing in interoperable electronic health records (EHR) systems can help ensure that all providers have access to a patient's test history, thereby avoiding unnecessary repeat tests.
The steps to address code M71 involve a thorough review of the patient's billing records to identify any duplicate test charges. Begin by comparing the dates of service and the procedure codes to ensure that the same tests have not been billed more than once for the same date or for overlapping periods. If duplicates are found, adjust the billing records accordingly and resubmit the claim with the correct information. If the tests were medically necessary and performed on different dates, provide detailed documentation and a clear explanation to justify the separate charges. Communicate with the payer if further clarification is needed to resolve the issue and secure proper payment. Additionally, implement internal auditing measures to prevent future occurrences of overlapping test charges.