DENIAL CODES

Denial code N628

Remark code N628 indicates that follow-up outpatient visits on the same day as a scheduled test or treatment are not permitted.

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What is Denial Code N628

Remark code N628 indicates that outpatient follow-up visits billed on the same date as a scheduled test or treatment are not permitted under the payer's policy.

Common Causes of RARC N628

Common causes of code N628 are scheduling errors where follow-up visits are inadvertently booked on the same date as a scheduled test or treatment, misunderstanding of billing guidelines regarding the timing of follow-up visits in relation to tests or treatments, and incorrect entry or processing of appointment dates in the practice management system. Additionally, lack of communication between scheduling and billing departments about the appropriate timing for follow-up visits can also lead to this issue.

Ways to Mitigate Denial Code N628

Ways to mitigate code N628 include implementing a comprehensive scheduling system that flags potential same-day follow-up visits and tests or treatments to prevent overlaps. Training staff to recognize and address these scheduling conflicts during appointment setting is crucial. Additionally, establishing a protocol for reviewing and adjusting the day's schedule to identify and rectify any instances where follow-up visits are booked on the same date as tests or treatments can help avoid this issue. Utilizing software that automatically checks for and alerts about such scheduling conflicts before finalizing appointments can also be an effective strategy.

How to Address Denial Code N628

The steps to address code N628 involve a multi-faceted approach to ensure compliance and optimize revenue. First, review the patient's appointment and billing records to confirm the accuracy of the claim submission that triggered the N628 code. If the follow-up visit was indeed billed on the same date as a scheduled test or treatment, separate the billing for these services to different dates, if clinically appropriate and in line with patient care protocols.

Next, educate both clinical and administrative staff on the importance of scheduling follow-up visits on different dates from tests or treatments, whenever possible. This includes training on how to document the necessity of follow-up visits distinctly from the test or treatment to avoid future occurrences of this code.

Additionally, implement a pre-billing audit process that specifically checks for potential N628 triggers, such as follow-up visits and tests or treatments scheduled on the same date. This process should include a review mechanism that flags these instances before claims are submitted, allowing for corrective action to be taken.

If the code appears due to an error in claim submission or a misunderstanding of the billing guidelines, prepare and submit a detailed appeal to the payer. This appeal should include documentation that either justifies the medical necessity of the follow-up visit on the same date as the test or treatment or clarifies any errors in the initial billing.

Lastly, consider leveraging technology solutions that can flag potential N628 codes before claim submission. These solutions can analyze scheduling and billing data to identify potential conflicts, allowing for preemptive adjustments and reducing the likelihood of receiving N628 codes in the future.

CARCs Associated to RARC N628

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