Remark code N658 is an alert that the billed services are not recognized as medical expenses by the payer.
Remark code N658 is an indication that the services billed were not recognized as medical expenses by the payer. This means that the payer does not consider the submitted services or procedures to be necessary for the diagnosis or treatment of a health condition, and therefore, they are not covered under the patient's health plan.
Common causes of code N658 are incorrect billing for services that are deemed non-medical by the payer, coding errors that misrepresent the nature of the service provided, billing for services that are considered part of another service or procedure already billed, and lack of necessary documentation to prove the medical necessity of the service.
Ways to mitigate code N658 include ensuring that the services provided are covered under the patient's current insurance plan by conducting thorough eligibility and benefits verification prior to the appointment. It's also crucial to stay updated on the payer's guidelines regarding what constitutes a medical expense. Regular training for coding staff on the latest coding standards and payer-specific guidelines can help avoid misinterpretations that lead to this code. Additionally, implementing a pre-authorization process for services that may fall into gray areas regarding coverage can prevent this issue. Lastly, maintaining open communication with payers to clarify ambiguous cases and using detailed documentation to support the medical necessity of the services can also be effective strategies.
The steps to address code N658 involve a multi-faceted approach to ensure that the services billed are accurately recognized as medical expenses. Initially, review the claim to verify that the correct codes were used for the services provided. If a coding error is identified, correct the codes and resubmit the claim. In cases where the coding is accurate, compile and submit detailed documentation that substantiates the medical necessity of the services. This documentation may include medical records, physician notes, and any relevant clinical guidelines or research that supports the service as a medical expense. If the claim is denied again, consider reaching out to the payer for a more detailed explanation of the denial and to discuss the possibility of an appeal. Throughout this process, maintain clear and detailed records of all communications and submissions to support any necessary appeals or further discussions with the payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
