Remark code N43 indicates that the number of days the patient's bed was held while they were on leave from the hospital, or the number of leave days, has exceeded the limit covered by the payer's policy. This could impact reimbursement as additional days beyond the limit may not be covered.
Common causes of code N43 are when a patient's stay in a hospital or skilled nursing facility extends beyond the number of days that insurance will cover for a bed hold during a temporary absence, or when the patient takes leave from the facility for non-medical reasons and the allotted leave days have been surpassed according to the patient's benefit plan.
Ways to mitigate code N43 include implementing a robust tracking system to monitor the number of bed hold or leave days accrued by each patient. Ensure that your administrative staff is well-trained on the facility's policies regarding the maximum allowable bed hold or leave days. Regularly review patient statuses and communicate with patients and their families about the limits and potential financial responsibilities if the threshold is approached or exceeded. Establish a protocol for timely discharge planning and coordination with patients who are nearing the maximum number of bed hold days to prevent unnecessary extensions. Additionally, consider setting up automated alerts in your RCM system to notify the relevant staff when a patient is close to exceeding their bed hold or leave days.
The steps to address code N43 involve several key actions. First, review the patient's admission and discharge dates alongside the facility's policy on bed hold or leave days to confirm the accuracy of the claim. If the claim is accurate and the limit has indeed been exceeded, communicate with the patient or their representative to discuss potential financial responsibilities. Next, explore if there are any extenuating circumstances or exceptions that could apply to the patient's situation that may warrant an appeal. If an appeal is appropriate, gather all necessary documentation and submit the appeal according to the payer's guidelines. In parallel, adjust your billing records to reflect the updated status of the bed hold or leave days for accurate future claims. Lastly, consider updating your internal policies or patient communication strategies to prevent similar issues from occurring, ensuring that patients are fully informed about their benefits and the limitations regarding bed hold or leave days.