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Claims Processing Issues Log
Please reference this page for confirmed system-related claims processing issues before you contact the Provider Contact Center. Click on the description of the issue to view detailed information and check back often for updates that are posted when they become available.
Closed issues remain on the active log for approximately 60 days before they are moved to the resolved issues archive list at the bottom of the page.
If you still have questions please contact the Provider Contact Center or use one of our self-service tools.
Date Reported |
Description of Issue |
01.11.2023 |
Some Home Health Claims Editing for Reason Code 31755 |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
31755 |
|
|
Updates |
Some home health claims are being returned for Reason Code 31755. The majority of the claims being returned are provider billing errors and need to be corrected with the information provided in the "Provider Action" section of this article. However, Medicare is still receiving claims for January 2022 that used the artificial admit date that have a different 0023 vs first visit date. We are researching what action to take on these claims.
Please see the below additional information as to why Reason Code 31755 was reactivated and why.
As of January 3, 2023, reason code 31755 has been reactivated per CMS instructions. This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim. |
MAC Action |
The issue is being researched. |
Provider Action |
Home health agencies need to ensure that:
- For initial periods of care, the HHA reports on the 0023 revenue code line the date of the first covered visit provided during the period.
- For subsequent periods, the HHA reports on the 0023 revenue code the date of the first visit provided during the period, regardless of whether the visit was covered or non-covered.
Many of the subsequent period claims are reporting the first day of the period rather than the first visit date, which are being correctly returned to the provider. Providers should correct the date and resubmit the claim. See page 61 of Chapter 10 - Home Health Agency Billing for more information.
No additional provider action is needed at this time. We will provide an update as soon as it is available. |
Proposed Resolution |
|
|
08.02.2022 |
Home Health claims submitted with condition code DR (disaster related) during the COVID-19 public health emergency that are not matched to a corresponding OASIS assessment in iQIES cannot finalize. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
N/A |
Condition Code DR |
|
Updates |
|
MAC Action |
CGS will remove condition code DR from affected claims to allow them to return to provider (RTP) with reason code 37253 correctly and include the following message in the Remarks field on claim page 07: DR condition code not needed. Removed so provider can submit matching OASIS. |
Provider Action |
Condition Code DR is not required since there is no waiver of OASIS reporting in place during the COVID-19 PHE.
If a claim RTPs per the MAC Action section above, submit the missing OASIS assessment and resubmit the claim. |
Proposed Resolution |
|
|
06.22.2022 |
Some home health claims received a partial episode payment (PEP) adjustment in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
|
Patient discharge status code 06; Reason Code 37184 |
|
Updates |
10.06.2022 – A system fix will be implemented on April 3, 2023. Please reference MM12924 for additional information. |
MAC Action |
|
Provider Action |
|
Proposed Resolution |
The maintainers are researching this issue. |
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