License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

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The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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May 18, 2020

Top Claim Submission Errors For Home Health and Hospice: Data and Resources!

Claim submission errors (CSEs) cause your billing transactions to either reject or move to your Return to Provider (RTP) file for correction. This causes your agency unnecessary time and money for staff to make corrections to claims in RTP. Historically, the home health reason code 38107 and hospice reason code 37402 (sequential billing) are the top claim submission errors each month, yet, they can be easily avoided. Please review the following data and the resources available to help your staff avoid these reason codes.

Reason Code 38107

Reason code 38107 will apply to home health final claims when a processed, matching request for anticipated payment (RAP) cannot be found. The following chart shows the number of providers, claims and beneficiaries affected by this reason code for the months of January, February and March 2020.

This chart shows the number of providers, claims and beneficiaries affected by this reason code for the months of January, February and March 2020.

The following chart identifies the total charges of the claims affected by this reason code in January, February, and March 2020.

This chart identifies the total charges of the claims affected by this reason code in January, February, and March 2020.

38107 Resources:

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.
Reason Code 38107 Web page – This web page explains the reason for the error, and steps on how to prevent reason code 38107.
Top Claim Submission Errors (CSEs) for Home Health Providers – This May 7, 2020 webinar recording covers the top claim submission errors for home health providers.
Medicare Claims Processing Manual (Pub. 100-04, Ch. 10) This provides information on each of the data elements entered on RAPs and final claims.

Reason Code 37402

Reason code 38107 will apply to hospice claims when the previous claim is not found or there is a gap between the "To" date of the previous claim and the "From" date on the next claim. The following chart shows the number of providers, claims and beneficiaries affected by this reason code for the months of January, February and March 2020.

37042 billing error

The following chart identifies the total charges of the claims affected by this reason code in January, February, and March 2020.

screenshot

37402 Resources

The following resources are available for assistance with avoiding/reducing the number of your claims that receive reason code 37402. Please share these with your billing staff.

Reason Code 37402 – This web page explains the reason for the error, and steps on how to prevent reason code 38107.
Hospice Sequential Billing web page – This information provides step by step instructions to meet the sequential billing requirements.
Top Claim Submission Errors (CSEs) for Hospice Providers – This May 6, 2020 webinar recording covers the top claim submission errors for hospice providers.

Remember, as a Medicare provider, you are responsible to ensure claims submissions are compliant with Medicare regulations. Please share this with your appropriate staff.