DENIAL CODES

Denial code 137

Denial code 137 is for regulatory surcharges, assessments, allowances, or health-related taxes that were not approved for reimbursement.

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What is Denial Code 137

Denial code 137 is related to regulatory surcharges, assessments, allowances, or health-related taxes. This means that the claim has been denied because it includes charges or taxes that are not allowed or covered by the payer or regulatory guidelines. It could be that the specific surcharges, assessments, allowances, or taxes mentioned in the claim are not recognized or approved by the payer, or they may exceed the allowable limits set by the regulatory authorities. As a result, the claim is denied, and the healthcare provider may need to review and adjust the charges or taxes mentioned in the claim before resubmitting it for reimbursement.

Common Causes of CARC 137

Common causes of code 137 are:

1. Inaccurate billing: This code may be triggered if the healthcare provider has incorrectly included regulatory surcharges, assessments, allowances, or health-related taxes in the patient's bill. It is important to ensure that only valid charges are included in the billing statement.

2. Lack of supporting documentation: If the healthcare provider fails to provide sufficient documentation or evidence to support the regulatory surcharges, assessments, allowances, or health-related taxes included in the bill, it can result in a denial with code 137. It is crucial to maintain proper documentation to substantiate these charges.

3. Non-compliance with regulatory requirements: Code 137 may be assigned if the healthcare provider fails to comply with specific regulatory requirements related to surcharges, assessments, allowances, or health-related taxes. It is essential to stay updated with the latest regulations and ensure compliance to avoid denials.

4. Incorrect coding: If the healthcare provider uses incorrect codes or modifiers while billing for regulatory surcharges, assessments, allowances, or health-related taxes, it can lead to a denial with code 137. Accurate coding is crucial to ensure proper reimbursement and avoid denials.

5. Lack of communication with payers: Failure to communicate and coordinate with payers regarding the inclusion of regulatory surcharges, assessments, allowances, or health-related taxes can result in denials with code 137. It is important to establish effective communication channels to address any payer-specific requirements or questions.

6. Insufficient knowledge of payer policies: Each payer may have specific policies and guidelines regarding the inclusion of regulatory surcharges, assessments, allowances, or health-related taxes. If the healthcare provider is unaware of these policies or fails to adhere to them, it can lead to denials with code 137. It is crucial to understand and follow payer-specific guidelines.

7. Billing errors: Any general billing errors, such as incorrect patient information, missing or incomplete data, or other inaccuracies, can result in denials with code 137. It is important to review and double-check all billing information to ensure accuracy and completeness.

8. Lack of proper documentation for exemptions: If the healthcare provider claims exemptions for certain regulatory surcharges, assessments, allowances, or health-related taxes but fails to provide proper documentation to support these exemptions, it can result in denials with code 137. It is essential to maintain and provide the necessary documentation to validate any exemptions claimed.

Remember, addressing these common causes can help healthcare providers reduce denials with code 137 and improve their revenue cycle management processes.

Ways to Mitigate Denial Code 137

Ways to mitigate code 137, which pertains to Regulatory Surcharges, Assessments, Allowances or Health Related Taxes, include:

1. Stay updated with regulatory changes: Regularly monitor and stay informed about any changes in regulations related to surcharges, assessments, allowances, or health-related taxes. This will help you understand the requirements and ensure compliance, reducing the chances of denials.

2. Accurate documentation: Ensure that all documentation related to surcharges, assessments, allowances, or health-related taxes is accurate and complete. This includes providing the necessary supporting documents and ensuring that all relevant information is included in the claim.

3. Proper coding: Assign the correct codes for surcharges, assessments, allowances, or health-related taxes. Use the appropriate coding guidelines and ensure that the codes accurately reflect the services provided or the taxes applicable.

4. Thorough verification: Verify the eligibility and coverage of patients before providing services. This will help identify any potential issues related to surcharges, assessments, allowances, or health-related taxes beforehand, allowing you to address them proactively.

5. Clear communication: Maintain open lines of communication with payers and other relevant parties. If there are any questions or concerns regarding surcharges, assessments, allowances, or health-related taxes, reach out to the appropriate contacts to seek clarification and resolve any issues promptly.

6. Utilize technology: Leverage technology solutions, such as revenue cycle management software, to streamline the billing and coding process. These tools can help identify any potential errors or discrepancies related to surcharges, assessments, allowances, or health-related taxes, allowing you to rectify them before submitting the claim.

7. Regular audits: Conduct regular internal audits to identify any potential issues related to surcharges, assessments, allowances, or health-related taxes. This will help you identify any patterns or trends that may be leading to denials and take corrective actions accordingly.

By implementing these strategies, healthcare providers can mitigate code 137 denials related to Regulatory Surcharges, Assessments, Allowances, or Health Related Taxes, ensuring a smoother revenue cycle management process.

How to Address Denial Code 137

The steps to address code 137, which indicates Regulatory Surcharges, Assessments, Allowances, or Health Related Taxes, are as follows:

1. Review the claim: Carefully examine the claim to ensure that all relevant charges, assessments, allowances, or taxes have been accurately documented and included.

2. Verify compliance: Check if the regulatory surcharges, assessments, allowances, or health-related taxes are in line with the applicable regulations and guidelines. Ensure that the charges are valid and supported by the necessary documentation.

3. Investigate discrepancies: If there are any discrepancies or inconsistencies in the charges, assessments, allowances, or taxes, investigate the root cause. Determine if there was an error in coding, billing, or documentation that led to the incorrect or disputed charges.

4. Communicate with relevant parties: Reach out to the appropriate departments or individuals within your organization to gather additional information or clarification regarding the regulatory surcharges, assessments, allowances, or health-related taxes. This may involve contacting the finance department, compliance officers, or other relevant stakeholders.

5. Provide supporting documentation: Compile all necessary supporting documentation, such as invoices, receipts, or other relevant records, to substantiate the charges, assessments, allowances, or taxes. Ensure that these documents are readily available for any potential audits or inquiries.

6. Appeal or resubmit if necessary: If you believe that the code 137 denial is incorrect or unjustified, consider appealing the denial or resubmitting the claim with the appropriate corrections and supporting documentation. Follow the established procedures and timelines for appeals or resubmissions as per your organization's policies.

7. Monitor and track: Keep track of the progress of the claim and any subsequent actions taken to address the denial. Maintain a record of all communication, documentation, and outcomes related to the code 137 denial for future reference and audit purposes.

By following these steps, healthcare providers can effectively address code 137 denials related to regulatory surcharges, assessments, allowances, or health-related taxes, ensuring accurate reimbursement and compliance with applicable regulations.

RARCs Associated to CARC 137

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