M71Remark Code (RARC)Active
M71 Remark Code - Total Payment Reduced for Overlap
The M71 remark code indicates that the total payment has been reduced because there was an overlap of tests billed. This suggests that the payer has identified duplicate or redundant testing services on the claim, leading to a decreased reimbursement amount.
How It Relates to the Denial
The M71 remark code typically accompanies Claim Adjustment Reason Codes that also address payment reductions due to overlapping services. This combination signals to the biller that the payer has determined certain billed tests are not eligible for full payment because they are considered duplicative.
Common Scenarios
1A laboratory billed for both a comprehensive metabolic panel and a basic metabolic panel for the same patient visit. The remittance shows a reduction in payment due to overlapping tests.
→ The M71 remark code indicates that the payer reduced the payment because the tests billed overlap in the services provided, suggesting that only one of the tests may be reimbursable.
2A provider submitted claims for two different imaging tests performed on the same day. The remittance advises that payment has been adjusted due to overlap, as indicated by the M71 code.
→ In this case, the M71 remark code points out that the payer believes there is an overlap in the services billed, which justifies the reduction in payment.
3A physical therapy clinic billed for multiple evaluations on the same day for a patient. The remittance response includes the M71 code, indicating a payment decrease.
→ This means that the payer has identified that the evaluations overlap, leading to a reduction in the total payment due to the M71 remark code.
What to Do
- Review the claim details to identify which tests or services are considered overlapping by the payer.
- Consider whether any adjustments or re-billing may be appropriate based on the payer's determination of overlap.
- If applicable, provide documentation that supports the necessity of each test billed to the payer.
What to Check
- The claim submitted to ensure accurate coding and billing of services.
- The payer's policy regarding overlapping tests to understand their criteria for payment reductions.
- The original adjustment reason code that accompanies the M71 remark code for further context on the payment reduction.