DENIAL CODES

Denial code N47

Remark code N47 indicates a claim denial due to a conflict with another inpatient stay, requiring review.

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What is Denial Code N47

Remark code N47 indicates that the claim submitted cannot be processed because it overlaps or conflicts with another claim that has been submitted for an inpatient stay. This suggests that the dates of service for the current claim coincide with the dates of service for a previously submitted claim where the patient was reported as being admitted to an inpatient facility. The provider will need to review the claim details and possibly coordinate with the payer to resolve the issue and determine the appropriate course of action for resubmission or correction.

Common Causes of RARC N47

Common causes of code N47 are:

1. The patient was admitted to another facility and an inpatient claim for that stay is already on file, creating a conflict with the new claim.

2. The dates of service on the claim overlap with an inpatient stay that has been previously billed and adjudicated.

3. There may be an error in the patient's discharge and readmission dates, causing the system to flag an overlap.

4. The claim may have been submitted with incorrect patient information, leading to a mismatch with an existing inpatient stay under the correct patient details.

5. The patient may have been transferred from one facility to another without proper coordination and documentation, resulting in concurrent inpatient stay claims.

6. There could be a lack of coordination between providers, causing both to submit claims for an inpatient stay covering the same dates of service.

7. The claim may be a duplicate of another claim that has already been processed for the same inpatient stay.

Ways to Mitigate Denial Code N47

Ways to mitigate code N47 include implementing a robust patient tracking system that records and verifies patient admission and discharge dates across all facilities. Ensure that your billing department communicates effectively with the admissions and discharge departments to confirm the accuracy of inpatient stay dates before claims submission. Regularly train staff on the importance of accurate and timely documentation of patient stays. Utilize claim scrubbing software that flags potential conflicts with previous inpatient stays, allowing for preemptive correction. Establish a protocol for reviewing and reconciling inpatient stays within your electronic health records (EHR) system to prevent overlapping claims. Conduct periodic audits to identify patterns that may lead to this error and address them proactively.

How to Address Denial Code N47

The steps to address code N47 involve a thorough review of the patient's admission and discharge dates for all recent inpatient stays. First, verify the accuracy of the dates of service on the claim in question. If the dates are correct, check for any overlapping dates with other inpatient claims that may have been submitted for the same patient. If an overlap is identified, determine which claim has the correct dates of service and whether one of the stays was incorrectly classified as inpatient when it should have been outpatient or observation.

Next, contact the other facility or provider involved in the conflicting inpatient stay to reconcile the discrepancy. If the conflict is due to an error on your claim, submit a corrected claim with the accurate dates of service. If the error is on the other provider's claim, coordinate with them to ensure they submit a corrected claim.

If the conflict arises from a patient being transferred from one facility to another, ensure that the transfer paperwork is in order and that the claims reflect the transfer accurately. In some cases, a transfer may not have been communicated properly between facilities, leading to overlapping claims.

Document all findings and communications with other providers or facilities. If necessary, provide this documentation to the payer to support the resolution of the conflict. If the issue persists, consider reaching out to the payer for further clarification on how to resolve the conflict and ensure that both inpatient stays are appropriately accounted for and reimbursed.

CARCs Associated to RARC N47

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