Remark code M91 indicates that laboratory procedures that are associated with different Clinical Laboratory Improvement Amendments (CLIA) certification numbers must be billed on separate claims. This means that if a healthcare provider is submitting claims for lab tests that were performed under different CLIA certifications, each set of tests under a unique CLIA number should be on its own claim form to ensure proper processing and payment by the payer.
Common causes of code M91 are:
1. Multiple laboratory procedures were performed under different CLIA (Clinical Laboratory Improvement Amendments) certification numbers but were included on the same claim form, which is not compliant with billing regulations.
2. The billing department may have inadvertently combined tests with different CLIA certification numbers due to a misunderstanding of the billing requirements for lab procedures.
3. There could be an error in the practice management system where lab procedures are not properly segmented by their respective CLIA certification numbers during the claim generation process.
4. The claim submission could reflect an oversight by the coding staff, who may not have been aware of the necessity to separate lab procedures by CLIA certification for billing purposes.
5. There may have been a change in laboratory service providers, resulting in different CLIA certifications that were not updated or communicated effectively within the billing system.
Ways to mitigate code M91 include ensuring that lab procedures are grouped correctly according to their respective CLIA certification numbers before billing. It's essential to verify that the lab services being billed under one claim are all covered by the same CLIA certificate. If multiple lab tests with different CLIA certifications are required for a patient, separate claims should be prepared for each group of tests under the same certification.
Implementing a robust checking system within your billing software to flag claims with mixed CLIA numbers can help prevent this issue. Additionally, staff training on the importance of matching lab procedures to the correct CLIA certification numbers during the billing process is crucial. Regular audits of billing practices can also help identify and rectify any recurring issues related to CLIA number discrepancies before claims are submitted.
The steps to address code M91 involve reviewing the claim to identify the laboratory procedures that have been billed together. Once identified, separate the procedures based on their respective Clinical Laboratory Improvement Amendments (CLIA) certification numbers. Create individual claims for each set of procedures that share the same CLIA certification number. Ensure that all other claim details, such as patient information and dates of service, are accurate and correspond to each set of procedures. After reorganizing the claims accordingly, resubmit them to the payer for processing. It's also advisable to check your billing system to see if it can be configured to flag or automatically separate claims based on CLIA numbers to prevent this issue from recurring in the future.