Remark code N162 is an alert indicating that while the current claim has been paid, it includes a test or specialty service that is not covered under the provider's current Laboratory Certification. The code serves as a warning that if the provider does not update their Laboratory Certification information to include this test or specialty, future claims for such services will be denied.
Common causes of code N162 are:
1. The healthcare provider billed for a laboratory test or service that is not covered under their current Clinical Laboratory Improvement Amendments (CLIA) certification.
2. There may have been an error in the billing process where the test code submitted does not match the list of approved tests for the provider's CLIA certificate.
3. The provider's CLIA certification may have lapsed or not been updated to include new or additional tests that the laboratory has begun performing.
4. The claim was submitted with incorrect or outdated information regarding the laboratory's certification status.
5. The laboratory performed a test that is outside the scope of their specialty as defined by their CLIA certification, and this was not caught before the claim was submitted.
Ways to mitigate code N162 include ensuring that your laboratory's Clinical Laboratory Improvement Amendments (CLIA) certification is up-to-date and includes all the tests and specialties for which you are billing. Regularly review the list of services covered under your current certification and compare it with the tests you are performing and billing for. If there are discrepancies, take immediate action to update your CLIA certification to reflect the accurate scope of your laboratory services. Additionally, implement a system to cross-check billing codes against your CLIA certification before submitting claims to prevent billing for non-certified tests. Training staff on the importance of this compliance and establishing a protocol for regular audits can also help in avoiding this issue.
The steps to address code N162 involve verifying and updating your Laboratory Certification to include the test or specialty for which you have billed. Begin by reviewing the current Clinical Laboratory Improvement Amendments (CLIA) certification to ensure that all tests or specialties provided are listed. If the test or specialty is not included, contact the appropriate certifying agency to initiate an amendment to your CLIA certification. Once the certification has been updated, resubmit the claim with the correct certification information. Additionally, implement a process to regularly review and update your laboratory's certification to prevent future remark codes like N162.