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The Case of the Rogue Remark Codes

Remark Codes are like a good mystery novel. They provide suspense, drama and a healthy dose of plot twists as you try to figure out what happened to your denied claim. When working on this mystery, you may be able to easily find clues through some analysis reports that will help you solve “The Case of the Rogue Remark Codes.”

According to the Washington Publishing Company, Remark Codes “convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code.” Essentially, these codes provide organizations with critical information about the adjudication of a claim and explain why the adjustment was made.

For you and your practice, these codes can contain clues about what happened to the claim and why it was denied or adjusted. Unfortunately, only about 3% of all remittances will include one or more Remark Codes. So, your first task to solve this mystery is to simply find the Remark Codes that are coming back from payers. If you are part of a medium to large practice, it can take a lot of work to find all unique Remark Codes and sum the denied amounts for each. In some instances, your clearinghouse may provide a reporting tool that can help you easily generate a list the top denied Remark Codes and the amount of money that was denied. (If you don’t have a reporting tool such as this, you may want to ask your clearinghouse about other reporting options that will give you this information.) As you go through this list, you will see some results that you expected, but others may come as a shock…just like a mysterious new character, which shows up midway through your favorite mystery novel! And it is these codes that you did not notice before that can be a silent drain on your revenue. For example, I recently ran this analysis for one practice, and the report show that the organization had denials totaling over $2,800 for one specific Remark Code that was not very common – N280.

Once I saw this troubling figure, I started to do some additional digging to determine the root cause of this issue. The first step I took was to run another analysis report through the clearinghouse’s reporting tool. Within a few clicks, I was able to determine that all of the mysterious Remark Codes were connected to one specific payer. If you see the same results when you run this type of analysis, I suggest that you question your payer representative about these denials and see if they have an airtight alibi!

Sometimes a good mystery is solved by finding out that the culprit worked on the inside.  Surely this rogue Remark Code N280 is not associated with only one of the providers in the practice…is it? Since I wanted to be thorough with this analysis, I ran one final report through the clearinghouse’s tool. As I looked at the results, I learned that there was in fact one provider connected with all of the rogue Remark Codes! The proof was in the data!

What if you combine the clues from looking at the Payers and Providers? Just as in the board game Clue, if you do this you will solve the mystery and win the game! In our example, it was a specific provider and a specific payer that combined to cause the rogue N280 Remark Code. Now you can work with both parties to determine how to correct this issue. Mystery solved!