Denial code 267 is for claims that span multiple months. It requires at least one Remark Code to be provided, which can be either an NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT.
Denial code 267 means that the claim or service being submitted spans multiple months, and it requires at least one remark code to be provided. The remark code can be either the NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT.
Common causes of code 267 are:
1. Missing or incomplete documentation: The claim may be missing the necessary documentation to support the services provided over multiple months. This could include the lack of a detailed treatment plan or progress notes that clearly indicate the need for services spanning multiple months.
2. Incorrect coding: The coding on the claim may be incorrect, leading to the denial. This could include using the wrong procedure or diagnosis codes, or failing to properly indicate the duration of the services provided.
3. Lack of medical necessity: The payer may determine that the services provided over multiple months were not medically necessary. This could be due to a lack of supporting documentation or failure to meet the payer's criteria for extended services.
4. Inadequate billing practices: The claim may not have been submitted with the necessary information or in the correct format. This could include missing required fields or failing to include the appropriate remark codes to explain the need for services spanning multiple months.
5. Payer-specific requirements: Each payer may have specific requirements for claims that span multiple months. Failure to meet these requirements, such as providing the necessary remark codes or using the correct format, can result in a denial with code 267.
It is important for healthcare providers to review their documentation, coding practices, and billing processes to ensure compliance with payer requirements and reduce the likelihood of denials with code 267.
Ways to mitigate code 267 include:
1. Ensure accurate and timely documentation: Make sure that all services provided over multiple months are properly documented and clearly indicate the duration of the treatment. This will help in justifying the need for spanning the claim/service across multiple months.
2. Use appropriate coding modifiers: Utilize the appropriate coding modifiers to indicate the span of the service. For example, modifiers such as "-52" (reduced services) or "-53" (discontinued procedure) can be used to indicate the partial completion or discontinuation of a service.
3. Provide detailed explanations: Include detailed explanations in the claim or supporting documentation to clarify the necessity of spanning the claim/service across multiple months. This can include information about the patient's condition, treatment plan, and any extenuating circumstances that justify the need for extended services.
4. Review and validate claims before submission: Conduct a thorough review of the claim to ensure that all necessary information, including any required remark codes, is included. This will help in avoiding any potential denials due to missing or incomplete information.
5. Stay updated with payer policies: Stay informed about the specific payer's guidelines and policies regarding claims that span multiple months. This will help in understanding any specific requirements or documentation needed to prevent denials related to code 267.
6. Implement effective communication channels: Establish effective communication channels with payers to address any questions or concerns regarding claims that span multiple months. This can help in resolving any potential issues or misunderstandings before the claim is submitted, reducing the likelihood of denials.
7. Monitor and analyze denial trends: Regularly monitor and analyze denial trends related to code 267 to identify any patterns or common issues. This will help in implementing proactive measures to prevent future denials and improve overall revenue cycle management.
By implementing these strategies, healthcare providers can mitigate code 267 and reduce the risk of denials related to claims or services spanning multiple months.
The steps to address code 267 are as follows:
1. Review the claim: Carefully examine the claim to ensure that it spans multiple months. This could occur if the services provided to the patient extend beyond a single billing period.
2. Verify the Remark Code: Check if the claim includes a Remark Code. This code should be either an NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT. If the code is missing or incorrect, it may be the cause of the denial.
3. Correct the Remark Code: If the Remark Code is missing or incorrect, update it with the appropriate code. Ensure that the code accurately reflects the reason for the denial and provides the necessary information for further processing.
4. Resubmit the claim: Once the Remark Code has been corrected, resubmit the claim for processing. Make sure to include all the required documentation and any additional information that may be necessary to support the claim.
5. Monitor the claim status: Keep track of the claim's progress and regularly check for updates. This will help ensure that the claim is being processed correctly and that any further issues or denials can be addressed promptly.
6. Analyze trends: If code 267 occurs frequently, analyze the underlying reasons for the denials. Look for patterns or common issues that may be causing the problem. This analysis can help identify areas for improvement in the revenue cycle management process and prevent future denials.
By following these steps, healthcare providers can effectively address code 267 and work towards resolving the denial in a timely manner.