Denial Code N520 can be the bane of a biller’s existence. It’s the one that signals a mismatch between procedure and revenue codes on facility claims. It’s not just a minor hiccup. Consider it a wrench in the gears that can stall your revenue cycle. Let's break down what this denial means and how to tackle it head-on.
Understanding the Mismatch
When you encounter Denial Code N520, the payer is essentially saying “Your procedure code doesn’t match the revenue code on the claim.” It’s like trying to fit a square peg into a round hole. This mismatch can delay payment or lead to outright claim rejection. Not something any practice wants.
The Culprit Codes
The procedure code — typically a CPT/HCPCS code — and the revenue code should align logically. For example, a CPT code for an X-ray must correlate with a revenue code that indicates radiology services. If a code meant for nursing services is paired with a procedure for surgical interventions, expect a denial.
Common Causes of Misalignment
Human Error
Let’s face it. Manual entry errors are common. Perhaps the biller selected a code one row above or below the intended choice. Simple but costly mistakes. And when you’re dealing with hundreds of claims, even a small error rate means significant lost revenue.
Software Glitches
Sometimes, the software itself can wreak havoc. An EHR or billing system might not update its code mapping after a system upgrade. Or maybe it’s a bug that slipped through quality control. Either way, these glitches can lead to automatic mismatches.
Policy Updates
Payers don’t always send a friendly memo when they update their coding requirements. A revenue code that was valid yesterday might not cut it today. It’s a moving target — one that’s easily missed if you’re not constantly vigilant.
Correcting Mapping Errors
Conduct Regular Audits
It’s not glamorous, but regular audits of your code mappings can preempt many issues. Set a schedule — monthly, quarterly, whatever works for your team — and stick to it. Review a sample of claims to catch anomalies before they snowball.
Leverage Technology
Use your billing software’s built-in tools to flag mismatches before claims go out the door. Many systems allow customization of edits and validations. If your tool doesn’t offer this, consider shopping around. Even if switching systems seems daunting, the upfront effort can pay off in fewer denials.
Stay Updated
Sign up for payer newsletters, attend industry webinars, or participate in coding forums. Knowing when payers change their requirements can save you from a world of denial pain. Make sure someone on your team owns this task.
Train and Retrain
Don't underestimate the power of education. Regular training sessions can keep your billing team sharp on coding practices. Run through common scenarios — like an X-ray paired with a nursing revenue code — as training exercises.
When It's Beyond Your Control
Engage with Payers
Sometimes, all the diligence in the world won’t prevent a denial if there’s an error on the payer’s end. If a revenue code suddenly starts triggering denials en masse, pick up the phone — or endure the dreaded hold music — and get a rep to confirm whether something changed on their end.
Document Everything
Keep meticulous records of any interactions with payers about coding changes or clarification. These records can be golden when appealing denials. They show you did your homework and can sometimes nudge a payer to reconsider their stance.
The Cost of Ignoring N520
This isn’t a denial code you want to ignore. Unchecked, N520 denials can lead to severe revenue impact. The time and resources spent correcting these claims could be used elsewhere if caught early. For a facility with a denial rate of just 3-5%, the losses can easily creep into tens of thousands of dollars monthly.
Moving Forward
Denial Code N520 isn’t just a simple mismatch — it’s a signal to revisit and refine your processes. With a proactive approach, you can turn these denials into rare occurrences rather than daily headaches. Keep your coding aligned, stay updated with payer policies, and make use of technology. This is how you keep the revenue cycle moving smoothly.
In the long run, attention to these details isn’t just about resolving today’s denials — it’s about building a robust system that prevents tomorrow’s.
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