Denial code N156

Remark code N156 indicates the patient owes the balance between the insurance-approved amount and the elective treatment cost.

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What is Denial Code N156

Remark code N156 indicates that the patient has chosen to receive a treatment or service that goes beyond what was approved or deemed medically necessary by their insurance plan. As a result, the patient is financially responsible for paying the difference in cost between the approved treatment and the elective, or chosen, treatment. This code is used to communicate to the healthcare provider that the excess charges should not be billed to the insurance payer but rather to the patient directly.

Common Causes of RARC N156

Common causes of code N156 are instances where a patient has chosen a treatment or service that goes beyond what their insurance plan has approved or considers medically necessary. This often occurs when a patient opts for a more expensive procedure or device that is not covered by their benefit plan, or when they select a provider or facility that is out-of-network and thus incurs higher charges. The code indicates that the patient has been informed and agrees to pay the difference in cost between what is covered by the insurance and the elective treatment they have chosen.

Ways to Mitigate Denial Code N156

Ways to mitigate code N156 include implementing a robust patient education program that clearly outlines the differences between approved and elective treatments. Ensure that all communication materials, such as brochures or digital content, detail the potential financial implications of choosing elective treatments over those approved by the payer. Train front desk staff and billing specialists to have transparent conversations with patients about their treatment options and associated costs prior to services being rendered.

Additionally, develop a standardized process for obtaining and documenting informed financial consent, where patients acknowledge their understanding of the costs for elective procedures not covered by their insurance. Utilize advanced eligibility verification tools to confirm coverage details and share this information with patients during the scheduling process. By taking these proactive steps, healthcare providers can reduce the likelihood of encountering code N156 and improve overall patient satisfaction with the billing process.

How to Address Denial Code N156

The steps to address code N156 involve several key actions to ensure proper billing and patient communication. First, review the Explanation of Benefits (EOB) to confirm that the services billed match the approved treatment and identify the elective treatment that was provided. Next, update the patient's account to reflect the additional charges for the elective treatment.

It is crucial to communicate clearly with the patient about their financial responsibility for the elective treatment. Provide a detailed statement that breaks down the costs of the approved treatment covered by insurance and the elective treatment that is the patient's responsibility. Educate the patient on the difference between medically necessary procedures and elective procedures, and ensure they understand why their insurance may not cover the latter.

If there are any discrepancies or if the patient disputes the charges, review the patient's consent forms and any pre-treatment estimates that were provided to confirm that the patient was made aware of and agreed to the financial responsibilities associated with the elective treatment.

Finally, set up a payment plan or discuss financial options with the patient if necessary, to collect the owed amount in a manner that is manageable for the patient while also ensuring that the healthcare provider receives payment for the services rendered.

CARCs Associated to RARC N156

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