DENIAL CODES

Denial code M75

Remark code M75 indicates that multiple automated tests done on the same day are bundled together for billing purposes.

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What is Denial Code M75

Remark code M75 indicates that multiple automated multichannel tests conducted on the same day have been consolidated for the purpose of payment. This means that if a healthcare provider performed several tests using automated processes on a patient within a single day, the payment for these services will be bundled together rather than reimbursed separately. This could impact the overall reimbursement amount, as the combined payment may be less than the sum of individual test charges. Providers should be aware of this when billing for multiple automated tests conducted on the same day to ensure accurate and optimized revenue cycle management.

Common Causes of RARC M75

Common causes of code M75 are scenarios where multiple diagnostic tests or procedures that were performed through automated systems across different channels or modalities are bundled together for the purpose of billing and payment. This can occur when:

1. The tests are considered related or complementary and are typically combined for billing efficiency.
2. The payer's policy dictates that certain tests, when performed on the same day by the same provider, should be consolidated into a single charge.
3. There is an overlap in the resources or equipment used for the tests, leading to a bundled payment arrangement.
4. The healthcare provider's billing system automatically groups certain test codes together to align with payer reimbursement policies.
5. The payer has specific rules for payment of multiple procedures or tests to prevent unbundling or to adjust reimbursement rates based on the total services provided in one day.

Ways to Mitigate Denial Code M75

Ways to mitigate code M75 include implementing a robust charge capture system that flags multiple automated multichannel tests ordered on the same patient for the same day. Ensure that your billing software is programmed to recognize and combine these tests for payment purposes. Educate your staff on the importance of reviewing test orders for duplication before submission and establish a protocol for combining tests where appropriate. Regularly audit your billing process to ensure compliance with this requirement and provide ongoing training to keep staff updated on any changes in billing practices related to multichannel tests.

How to Address Denial Code M75

The steps to address code M75 involve reviewing the claim to verify that the tests were indeed performed on the same day and are subject to combination for payment purposes. If the tests were correctly combined, no further action is necessary. However, if you believe the tests should be billed separately due to medical necessity or distinct testing protocols, you should gather supporting documentation, such as medical records or physician notes, to justify the separate charges. Then, resubmit the claim with the additional documentation and a clear explanation of why the tests should not be combined. If applicable, include modifier codes that reflect the distinct services provided. It may also be beneficial to check if there are any payer-specific guidelines regarding the billing of automated multichannel tests to ensure compliance with their policies.

CARCs Associated to RARC M75

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