Remark code N171 indicates that the payment request for repair or replacement services has been denied because either these services are not included in the patient's coverage benefits, or the cost for repair or replacement has surpassed the original purchase price of the item. This means that the healthcare provider will not receive reimbursement for these services under the current claim.
Common causes of code N171 are:
1. The claim submitted for the repair or replacement of durable medical equipment (DME) exceeds the original purchase price of the item, which is not allowed per the payer's policy.
2. The item in question may not be covered under the patient's current insurance plan for repairs or replacements.
3. The frequency of repairs or replacements may exceed the limitations set by the insurance policy, leading to a denial of additional payments.
4. The claim may lack necessary documentation or justification for the repair or replacement costs, resulting in the application of this code.
5. The repair or replacement may be deemed not medically necessary according to the payer's guidelines.
6. The code may be used if the warranty period for the item has not expired, and the payer expects the manufacturer to cover the costs instead.
7. The patient may have switched insurance carriers, and the new plan does not cover the costs associated with repair or replacement of the item in question.
Ways to mitigate code N171 include implementing a robust verification process to ensure that claims for repairs or replacements are within the coverage limits and do not exceed the original purchase price. Healthcare providers should maintain accurate records of equipment and supply costs, and regularly review payer contracts to stay informed about coverage restrictions related to repairs and replacements. Additionally, staff training on proper coding practices and regular audits of billing processes can help identify and address issues that may lead to this denial code. It's also beneficial to establish clear communication channels with suppliers to confirm the cost details before submitting claims.
The steps to address code N171 involve several key actions to resolve the issue. First, review the patient's medical record and the claim details to ensure that the repair or replacement service was accurately coded and medically necessary. Next, check the patient's insurance policy to confirm coverage limitations for repairs or replacements. If the service should be covered, prepare and submit a detailed appeal to the payer, including documentation that justifies the medical necessity and cost-effectiveness of the repair or replacement. If the appeal is denied or the service is indeed not covered, inform the patient of their financial responsibility and discuss alternative payment options or potential discounts for the service provided. Additionally, consider reaching out to the manufacturer or supplier for warranty information or potential discounts on the repair or replacement service.