October 27, 2020
Friendly Reminder: Reason Code 37253
For home health claims with From dates on or after January 1, 2020, matching your claim with the Outcome and Assessment Information Set (OASIS) is more important than ever. Reason code 37253 (no OASIS found) continues to be one of the top errors for home health providers.
In most cases, the claim and OASIS is not matching because the Medicare Beneficiary Identifier (MBI) doesn’t match, or the OASIS was not transmitted to Quality Improvement and Evaluation System (iQIES). Review the following Quick Tips to avoid your claims from going to the Return to Provider (RTP) file (status/location T B9997) with reason 37253. In addition, for more details, refer to the Reason Code Search and Resolution: Reason Code 37253 web page.
Quick Tips
- Review the OASIS FVR Report to ensure the OASIS assessment was successfully accepted.
- Check the FVR to confirm the receipt date shows the OASIS was accepted by iQIES before you submitted your claim.
- Check the Reason for Assessment (RFA) (OASIS Item M0100). It must be equal to 01, 03, 04, or 05.
- Check the occurrence code 50 and ensure that you are reporting the assessment completion date (Item M0090).
- Check the claim you submitted with the OASIS to ensure the following items match.
- CMS Certification Number (OASIS Item M0010)
- Medicare Beneficiary Identifier (MBI) (OASIS Item M0063)
- Assessment Completion Date (OASIS Item M0090)
- Check the iQIES website for known issues affecting the OASIS
If you find that the claim and OASIS have correct and matching information, contact the Provider Contact Center (PCC) at 1.877.299.4500 (Option 1).
Resources:
- Quick Reference Guide to OASIS Submissions and Final Validation Reports
- SE20010 MLN Matters article, Ensure Required Patient Assessment Information for Home Health Claims
Please share this with your appropriate staff.