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Reason Code Search and Resolution

Disclaimer: This is not a complete listing of reason codes.

This Reason Code Search and Resolution tool has been designed to aid Medicare providers in reviewing reason codes and how to resolve the edit or use them for determining if other action is needed. You may search this database by reason code or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of reason codes, their descriptions, resolutions, and additional billing information by clicking on the "Show all Reason Codes" option.

If no reason code displays, access the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) and select Option 17 “Reason Codes” from the Inquiry Menu to review the reason code description. For additional information refer to the Chapter 3: Inquiry MenuPDF of the FISS DDE Guide.

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Reason Code 31018

Description:

For claims with dates of service prior to January 1, 2020 under the Home Health Prospective Payment System (HH PPS):

  • There is a span of more than 60 days between the "FROM" and "TO" date submitted on the claim.
    • Example 1: "FROM" date billed is March 15 and the "TO" date billed is May 14, which equals 61 days
    • Example 2: "FROM" date billed is March 15, and the "TO" date billed is July 12, which equals 120 days
  • There is less than 60 days between the "FROM" and "TO" date submitted, and a patient status code "30" appears on the claim.
    • Example: "FROM" date billed is March 15 and the "TO" date billed is May 11, which equals 58 days. Patient status code "30" indicates the beneficiary remains a patient of the HHA at the end of the episode; therefore, the span between the "FROM" and "TO" dates cannot be less than 60 days.

For claims with dates of service on or after January 1, 2020, under the Patient-Driven Groupings Model (PDGM):

  • There is a span of more than 30 days between the "FROM" and "TO" date submitted on the claim.
    • Example 1: "FROM" date billed is March 15 and the "TO" date billed is April 14, which equals 31 days
    • Example 2: "FROM" date billed is March 15, and the "TO" date billed is May 13, which equals 60 days
  • There is less than 30 days between the "FROM" and "TO" date submitted, and a patient status code "30" appears on the claim.
    • Example: "FROM" date billed is March 15 and the "TO" date billed is April 11, which equals 28 days. Patient status code "30" indicates the beneficiary remains a patient of the HHA at the end of the period of care; therefore, the span between the "FROM" and "TO" dates cannot be less than 30 days.

Resolution:

Updated: 01/21/2020


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