September 27, 2017
Home Health No-Payment Billing (Condition Code 21)
CGS has seen instances where no payment claims are being submitted with the incorrect type of bill (TOB) 0329. No-payment claims are submitted to seek denials for the entire claim in cases where you know all services will not be covered by Medicare. Such denials allow providers to obtain a denial notice from Medicare for other payer consideration. According to CMS Pub. 100-04, Chapter 10, Section 60, a no-payment claim must be submitted with the 0320 TOB and condition code 21. Submitting an incorrect TOB will apply an incorrect denial reason code to the claim and may cause claim processing delays. For detailed billing information, refer to the CGS Home Health No-Payment Billing (Condition Code 21) Web page.