Nandi Posted Wed 06th of May, 2015 11:54:26 AM
We are receiving a denial code, N362- the number of days or units of service exceeds our acceptable maximum. How do we resolve this issue so that it doesn't happen again?
SuperCoder Answered Thu 07th of May, 2015 05:53:11 AM
N362 is the denial code for the number of days or units of Service exceeds acceptable maximum, means you have to check numbers of days or units applied of specific code you are billing for. If you receive a claim denial due to MUEs, you can appeal. You can appeal the claims and you can address inquiries regarding the rationale for an MUE. You should follow three steps during the appeals process:
• Step 1: Determine the reason for the denial. First, figure out if you made a coding or billing error. If you find a coding error- such as the wrong number of units entered in the units box- submit a corrected claim. If you don't find a coding or billing error, move on to the next step.
• Step 2: Decide if you have a legitimate reason to appeal. If you believe there is medical necessity for the services over and above the allowable under the MUE, you should appeal to the contractor. If there is no medical necessity, take a look again at coding. Make sure service is coded properly, and appropriate modifiers have been assigned.
• Step 3: Appeal the claim. File an initial appeal with your carrier and follow the standard five-level Medicare appeals process. If appealing the claim due to a clinical reason, you may wish to employ clinical expertise when putting together your appeal letter.
It is suggested to scrutinize your explanation of benefits (EOBs) to look for remark code N362. As this code represents "the number of days or units of service exceeds our acceptable maximum" and may mean your claim has fallen afoul of the MUEs.