DENIAL CODES

Denial code N671

Remark code N671 is an explanation for adjustments, indicating payment is aligned with the jurisdiction's cost-charge ratio.

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What is Denial Code N671

Remark code N671 indicates that the payment has been adjusted based on a jurisdiction-specific cost-charge ratio.

Common Causes of RARC N671

Common causes of code N671 are incorrect or outdated jurisdiction-specific cost-charge ratios applied to the claim, misclassification of the service area, or errors in the calculation of the cost-charge ratio by the billing entity.

Ways to Mitigate Denial Code N671

Ways to mitigate code N671 include implementing a robust charge master review process to ensure that charges are aligned with the current cost-charge ratios specific to the jurisdiction. Regularly updating the charge master to reflect accurate, compliant pricing can help avoid discrepancies that lead to this code. Additionally, conducting periodic audits of billed services against payments received can identify patterns or instances where jurisdiction-specific cost-charge ratios may not have been accurately applied, allowing for corrective action before claims are submitted. Training billing staff on jurisdiction-specific billing requirements and maintaining open communication with payers about cost-charge ratio expectations can also prevent this code from occurring.

How to Address Denial Code N671

The steps to address code N671 involve a multi-faceted approach to ensure that the payment received aligns with the expected reimbursement based on the jurisdiction's cost-charge ratio. Firstly, it's crucial to conduct an internal audit of the claim in question to verify the accuracy of the charges submitted. This includes reviewing the itemized bill to ensure that all services provided are correctly coded and priced according to the jurisdiction's guidelines.

Next, compare the payment received with the expected reimbursement, taking into account the specific cost-charge ratio applicable to your jurisdiction. This may require calculating the expected payment manually to identify any discrepancies between what was paid and what should have been paid.

If a discrepancy is identified, prepare a detailed appeal letter to the payer. This letter should include a clear explanation of why the payment received is considered incorrect, supported by evidence such as the internal audit findings, the correct cost-charge ratio calculations, and any relevant documentation that supports the claim for a higher reimbursement.

Additionally, it may be beneficial to engage in a dialogue with the payer's representative to discuss the specifics of the case. This conversation can provide further clarity on why the payment was adjusted according to the jurisdiction's cost-charge ratio and offer an opportunity to present your case for a revised payment.

Finally, to prevent similar issues in the future, review and possibly update your billing practices to ensure they align with the latest guidelines and cost-charge ratios for your jurisdiction. This may involve ongoing education for your billing staff on jurisdiction-specific billing requirements and regular audits of claims to catch and correct any potential issues before submission.

CARCs Associated to RARC N671

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