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November 26, 2019

Reducing Home Health Errors for Reason Codes (RC) 38107

Home health agencies (HHAs) are reminded of the following Medicare billing requirement that ensures your Requests for Anticipated Payment (RAPs) and final claims process and pay timely in the Fiscal Intermediary Standard System (FISS).

When a home health final claim is submitted to Medicare, the Fiscal Intermediary Standard System (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.  If a RAP is found, certain billing elements must match between the RAP and the final claim.

CGS claim submission error (CSE) data continually shows reason code 38107 at the top of the list.  CSE data for September and October 2019 show 14,803 claims went to the RTP file with this reason code.  CGS offers the following resources for assistance with avoiding/reducing the number of your claims that receive reason code 38107. Please share these with your billing staff.

NOTE: This requirement does not change with the implementation of the home health Patient-Driven Groupings Model (PDGM).

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