DENIAL CODES

Denial code N638

Remark code N638 indicates payment was adjusted based on the home health fee schedule.

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What is Denial Code N638

Remark code N638 indicates that reimbursement has been made according to the home health fee schedule.

Common Causes of RARC N638

Common causes of code N638 are incorrect billing for services that fall under the home health fee schedule, misclassification of the type of care provided, or errors in the application of the home health fee schedule rates during the billing process.

Ways to Mitigate Denial Code N638

Ways to mitigate code N638 include ensuring accurate and up-to-date documentation of all services provided, verifying the correct home health fee schedule is applied before submitting claims, and conducting regular audits to identify and correct any discrepancies in billing practices. Additionally, implementing a robust training program for billing staff on the latest home health fee schedule updates and reimbursement policies can help prevent this code from occurring. Engaging in proactive communication with payers to clarify any ambiguities related to home health fee schedules and reimbursement rates is also advisable.

How to Address Denial Code N638

The steps to address code N638 involve a multi-faceted approach to ensure that reimbursement aligns with the provided services and costs incurred. Initially, it's crucial to verify the accuracy of the billing information submitted, including the dates of service, the services provided, and the associated charges. If discrepancies are found, a corrected claim should be submitted with detailed documentation to support the services billed.

Next, review the home health fee schedule applicable to the date(s) of service to confirm that the reimbursement received matches the expected amount based on the schedule. If there are differences between the expected and received amounts, prepare a detailed comparison highlighting these discrepancies.

If after these steps the reimbursement still appears incorrect, consider reaching out directly to the payer for clarification. Provide them with a comprehensive overview of the services provided, the billing codes used, and how these align with the home health fee schedule. Be prepared to supply any additional documentation requested by the payer to substantiate the claim.

In cases where the payer maintains their reimbursement decision, evaluate the cost-benefit of appealing the decision. If an appeal is pursued, compile a robust evidence package that includes the claim details, the home health fee schedule, any relevant clinical documentation, and a letter explaining why the reimbursement received is believed to be incorrect.

Throughout this process, maintain detailed records of all communications and documentation exchanged with the payer. This will be invaluable not only for the current situation but also for identifying any patterns that may indicate systemic issues with how home health services are being reimbursed, allowing for more strategic future billing practices.

CARCs Associated to RARC N638

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