Denial code N606

Remark code N606 indicates the Oregon allowed amount for a procedure is based on the Workers Compensation Fee Schedule, as per ORS 742.524.

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What is Denial Code N606

Remark code N606 is an indication that the payment amount approved for the procedure in question is based on the Oregon Workers' Compensation Fee Schedule, as outlined in the Oregon Administrative Rules (OAR) 436-009. This means the amount paid or payable for this specific service has been determined in alignment with the regulations set forth in Section 4 of the Oregon Revised Statutes (ORS) 742.524.

Common Causes of RARC N606

Common causes of code N606 are incorrect billing for procedures not aligned with the Oregon Workers Compensation Fee Schedule, misapplication of the fee schedule rates to services provided, or errors in calculating the allowed amount in accordance with Section 4 of ORS 742.524. Additionally, this code may be used when there is a discrepancy between the billed amount and the state-mandated fee schedule for workers' compensation cases in Oregon.

Ways to Mitigate Denial Code N606

Ways to mitigate code N606 include ensuring that billing staff are thoroughly trained in the nuances of state-specific Workers Compensation Fee Schedules, particularly for Oregon. Regularly updating billing software and fee schedules in your system can help in accurately calculating allowed amounts. Additionally, implementing a pre-claim review process that specifically checks for compliance with the Oregon Administrative Rules (OAR) 436-009 and the relevant sections of the Oregon Revised Statutes (ORS) can prevent this code from arising. Engaging in continuous education about changes in workers' compensation regulations and maintaining open lines of communication with workers' compensation boards may also reduce the occurrence of this code.

How to Address Denial Code N606

The steps to address code N606 involve a multi-faceted approach focusing on ensuring compliance with the specific fee schedule referenced. Firstly, review the current billing for the procedure in question to confirm that it aligns with the Oregon Workers Compensation Fee Schedule as outlined in OAR 436-009. This may involve cross-referencing the billed procedure codes with the fee schedule to ensure the charged amounts do not exceed the allowed amounts.

Secondly, if discrepancies are found between the billed amount and the allowed amount, adjustments should be made accordingly. This could involve issuing refunds if overpayments are identified or submitting adjusted claims to seek additional reimbursement if underpayments are discovered.

Additionally, it's crucial to update your billing software or system to reflect the correct allowed amounts for future billing. This may involve configuring the system to automatically apply the correct fees for services rendered under Oregon Workers Compensation cases, based on the fee schedule.

To prevent future occurrences of this code, consider implementing a routine audit process. This process should involve regularly reviewing billed services against the Workers Compensation Fee Schedule to ensure compliance. Regular training for billing staff on updates to the Workers Compensation Fee Schedule and related regulations is also advisable to maintain awareness and compliance.

Lastly, maintain open communication with the payer. If there are questions or uncertainties about how the allowed amount was calculated or how to apply the fee schedule correctly, reaching out to the payer for clarification can prevent future issues and ensure that billing practices align with payer expectations and regulations.

CARCs Associated to RARC N606

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