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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.

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.

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

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