Denial code 268 is when a claim spans two calendar years. Resubmit one claim per calendar year.
Denial code 268 is used when a claim spans two calendar years. It means that the claim needs to be resubmitted as separate claims, with one claim for each calendar year.
Common causes of code 268 are:
- The claim was submitted with dates that span two different calendar years.
- The healthcare provider mistakenly included services or procedures that were performed in different calendar years on a single claim.- The claim was not properly split into separate claims for each calendar year.
- The billing system or software used by the healthcare provider did not automatically split the claim into separate claims for each calendar year.- The healthcare provider did not accurately document the dates of service for the procedures or services included in the claim.
- The claim was submitted with incorrect or overlapping dates of service, causing it to span two calendar years.- The healthcare provider did not follow the specific billing guidelines or requirements set by the insurance payer for claims that span multiple calendar years.
- The claim was not properly reviewed or checked for errors before submission, leading to the inclusion of services from different calendar years on a single claim.
- The healthcare provider did not receive proper training or education on how to correctly submit claims that span multiple calendar years.
- The insurance payer's system flagged the claim for review or denial due to the presence of services or procedures from different calendar years.
Ways to mitigate code 268 include:
1. Splitting the claim: To prevent this code, ensure that claims are split based on the calendar year. Submit separate claims for services provided in different calendar years. This will help avoid the claim spanning multiple years and reduce the chances of receiving this denial code.
2. Timely submission: Submit claims promptly to avoid the claim crossing over into a new calendar year. Implement efficient processes to ensure claims are submitted in a timely manner, allowing ample time for processing and avoiding any potential issues related to the claim spanning multiple years.
3. Accurate date of service: Double-check the date of service on the claim to ensure it aligns with the correct calendar year. Mistakes in recording the date of service can lead to claims spanning multiple years and result in denial code 268. Implement checks and balances within your billing system to catch any discrepancies before submitting the claim.
4. Clear documentation: Ensure that all documentation related to the services provided clearly indicates the date of service. This includes medical records, encounter forms, and any other supporting documentation. Clear and accurate documentation will help prevent any confusion or errors that could lead to claims spanning multiple years.
5. Regular claim reviews: Conduct regular reviews of claims to identify any potential issues related to claims spanning multiple years. Implement a proactive approach to identify and address these issues before submitting the claim. This can help reduce the likelihood of receiving denial code 268.
By implementing these strategies, healthcare providers can mitigate denial code 268 and improve their revenue cycle management process.
The steps to address code 268 are as follows:
1. Review the claim: Carefully examine the claim to determine if it indeed spans two calendar years. Check the dates of service and ensure that they fall within different calendar years.
2. Split the claim: If the claim does span two calendar years, you will need to split it into two separate claims, each representing the services provided within a specific calendar year. This can typically be done within your billing software or practice management system.
3. Adjust claim details: Modify the necessary details on each split claim, such as the dates of service, to accurately reflect the services provided within the respective calendar year.
4. Resubmit the claims: Once the claims have been split and adjusted, resubmit them to the payer for processing. Ensure that all required documentation and supporting information are included with each claim.
5. Monitor payment and follow-up: Keep track of the status of each split claim and monitor the payment process. If any issues or delays arise, follow up with the payer to address any outstanding concerns and ensure timely reimbursement.
By following these steps, you can effectively address denial code 268 and ensure that your claims are processed correctly and in compliance with payer requirements.
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