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