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.
Refer to the following resources for assistance with avoiding/reducing the number of your claims that receive reason code 38107.
- Avoid Billing Error 38107 Online Education Course – This course includes audio and screen examples and will guide you through the steps to ensure you avoid reason code 38107.
- Avoiding Reason Code 38107 quick resource tool – This resource provides steps on how to check for processed RAPs, matching RAP and claim information, and checking for auto-canceled RAPs.
- Top Claim Submission Errors for Home Health Providers: Error 38107 Web page – This web page explains the reason for the error, and steps on how to prevent reason code 38107.
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 10) – This provides information on each of the data elements entered on RAPs and final claims.
- CGS Home Health Claims Filing webpages – This web page provides details about billing home health claims and RAPs.