Remark code N173 indicates that the claim has been processed but cannot be paid because the necessary information regarding the dates of a qualifying hospital stay for the episode of care in question has not been provided. The healthcare provider must submit the appropriate dates of the hospital stay to support the services billed in order to meet the requirements for payment.
Common causes of code N173 are:
1. The claim was submitted without including the dates of the inpatient hospital stay that is required for the specific service or procedure billed.
2. The inpatient stay dates provided do not meet the minimum length of stay required for the billed service.
3. There is a discrepancy between the dates of service on the claim and the actual hospital admission and discharge dates.
4. The claim was filed for a service that requires a preceding hospital stay, but the patient did not have a hospital admission for the condition being treated.
5. The hospital stay dates were entered incorrectly on the claim form, either due to a clerical error or misunderstanding of the required information.
6. The claim lacks the necessary documentation to support the hospital stay, such as an admission summary or discharge instructions, which are needed to validate the stay.
7. The patient's eligibility verification was not properly conducted, leading to a lack of information about a qualifying hospital stay.
8. The billing system may have automatically generated the claim without the required hospital stay information due to a technical error or setup issue.
Ways to mitigate code N173 include implementing a thorough pre-billing review process to ensure that all claims for episodes of care requiring a qualifying hospital stay include the necessary admission and discharge dates. Staff should be trained to verify that the hospital stay information is accurately documented in the patient's medical record before claim submission. Additionally, leveraging automated claim scrubbing software can help identify and flag claims that are missing these critical dates, allowing for correction prior to submission. Regular audits of claims denied for this reason can also help identify patterns or common errors that can be addressed through staff education or process improvement.
The steps to address code N173 involve verifying the patient's hospital admission and discharge dates. First, review the patient's medical records to confirm the dates of the hospital stay that corresponds with the episode of care in question. If the dates are accurate and simply were not included in the claim, amend the claim to include this information and resubmit it to the payer.
If the hospital stay dates are missing or incorrect in the medical records, coordinate with the hospital's admissions office to obtain the correct information. Once the accurate hospital stay dates are confirmed, update the patient's records and the claim, then resubmit the claim to the insurance company.
In cases where there was no hospital stay, but the service provided typically requires one, consult with the clinical team to understand the circumstances of the care episode. If the service was appropriately provided without a hospital stay, you may need to include a detailed explanation or additional documentation to support the claim when resubmitting.
Ensure that all resubmissions are done within the payer's timely filing limits and that any additional documentation requested by the payer is provided promptly to avoid further delays in payment.