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Reason Code Search and Resolution

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

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code 32243

Description:

A home health billing transaction (Request for Anticipated Payment, final claim or adjustment) was submitted without a 0023 revenue code line OR a revenue code line for a visit was billed without charges.

Resolution:

  • Ensure that all billing transactions submitted for services paid under the Home Health Prospective Payment System (HH PPS) include a 0023 revenue code line. See the screenprint of FISS Page 02 below. A revenue code 0003 was entered on line 1 instead of a revenue code 0023.

    32243

  • Ensure that charges are entered for all revenue code lines reporting supplies or a visit. In the example of FISS Page 02 below, revenue code lines 6, 7, and 8 were billed without charges, resulting in the claim being returned with reason code 32243.
    • Reminder: You may need to press the F5 and F6 keys when reviewing revenue code information on FISS Page 02 in order to determine which line item dates of service are missing charges.

      32243

Posted: 04.11.16

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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