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February 12, 2019

Reducing Home Health Errors for Reason Codes (RC) 38107

Home health agencies (HHAs) are reminded of the following Medicare billing requirements to ensure their Requests for Anticipated Payment (RAPs) and final claims process and pay timely in the Fiscal Intermediary Standard System (FISS).

RC 38107

When a home health final claim is submitted to Medicare, FISS will search for a matching RAP. FISS will send the final claim to the return to provider (RTP) file (status/location T B9997) with reason code 38107 when a matching RAP is not found, or when one or more of the following fields does not match between the RAP and the final claim.

January 2019 analysis of claim submission errors (CSEs) showed that 38107 accounted for 18% of all CSEs received by HHAs who bill to CGS.

FISS Field Name FISS Page UB-04 Form Locator (FL) Data Entered
NPI 1 60

National Provider Identifier (NPI) of the billing provider

STMT DATES FROM 1 6

Start of care (SOC) episodes only: Date of first Medicare billable visit in the episode

Recertification (subsequent) episodes: First calendar day of the episode of care

ADMIT DATE 1 12

Date of first Medicare billable visit in the beneficiary's initial episode with the primary HHA

HCPC 2 44

0023 revenue code line: Health Insurance Prospective Payment System (HIPPS) code. FISS compares the first four positions of the HIPPS code between the RAP and final claim for the same episode of care

SERV DATE 2 45

0023 revenue code line: First Medicare billable visit in the episode

Examples of FISS page 1 and page 2 are shown below with the matching fields indicated.

Screenshot

Refer to the following resources for assistance with avoiding/reducing the number of your claims that receive reason code 38107.

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