Remark code N213 indicates that the claim has been flagged due to missing, incomplete, or invalid information regarding the facility's Diagnostic Related Group (DRG) or the DRG exempt status. This information is essential for proper claim processing and reimbursement, as it relates to the classification system used to determine payments for hospital inpatient services. The healthcare provider needs to review and correct the DRG information on the claim before resubmitting it for payment consideration.
Common causes of code N213 are incorrect or missing entries regarding the Diagnosis-Related Group (DRG) status on the claim form, submission of claims without the necessary DRG information for facilities that are subject to DRG-based reimbursement, or the provision of DRG information that does not match the patient's diagnosis or procedure as recorded in the medical record. Additionally, this code may be triggered if there is a discrepancy between the billed services and the DRG exempt status, or if the documentation fails to substantiate the DRG or DRG exempt status that is claimed.
Ways to mitigate code N213 include implementing a robust pre-billing review process to ensure that all claims include complete and accurate Diagnosis-Related Group (DRG) or DRG exempt status information. This can be achieved by:
1. Training staff on the importance of capturing all necessary data elements related to facility or discrete unit DRG information during the patient intake and coding processes.
2. Utilizing advanced coding software that automatically checks for missing or invalid DRG information and prompts for correction before claim submission.
3. Establishing a routine internal audit program to identify and address any recurring issues with DRG information completeness and validity.
4. Keeping up-to-date with the latest DRG classification updates and ensuring that coding staff are educated on any changes.
5. Collaborating with clinical documentation improvement (CDI) specialists to ensure that the medical record accurately reflects the patient's condition and treatment, which directly impacts DRG assignment.
6. Creating a checklist for coders and billers to verify that DRG or DRG exempt status information is present and correct on each claim.
7. Streamlining communication between clinical and billing departments to quickly resolve any discrepancies or questions regarding DRG information.
By focusing on these strategies, healthcare providers can reduce the likelihood of receiving code N213 and improve the accuracy of their claims submissions.
The steps to address code N213 involve a thorough review of the claim to ensure that the Diagnosis-Related Group (DRG) or DRG exempt status information is accurately and completely documented. Begin by cross-referencing the patient's medical records with the claim to verify that the appropriate DRG has been assigned based on the diagnoses, procedures performed, and the level of care provided. If the DRG is missing or incorrect, reassign the correct DRG using the latest coding guidelines. For DRG exempt status, confirm whether the patient's treatment falls under DRG exemptions and update the claim accordingly. Once the necessary corrections are made, resubmit the claim with the complete and valid DRG or DRG exempt status information. It's also advisable to review your facility's coding and billing processes to prevent future occurrences of this error.