Skip to main content
Corporate

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.

Search by:

Reason Code U5194

Description:

The occurrence span code (OSC) 77 is missing or the dates are incorrect.

Resolution:

The hospice notice of election (NOE) must be received within 5 calendar days after the effective date of the hospice election. When the NOE is not received timely, Medicare will not cover/pay for days of care from the admission date to the date the NOE was submitted/accepted. OSC 77 must be reported to identify the dates from the date of admission to the date before the NOE was received.

Use FISS Option 12 to determine the date CGS received the NOE.

Example of timely/untimely NOE calculation:

  • Admission date = 10/10/YY
  • Day 1 = 10/11/YY
  • Day 2 = 10/12/YY
  • Day 3 = 10/13/YY
  • Day 4 = 10/14/YY
  • Day 5 = 10/15/YY (This is the NOE "due date")

If the NOE is received and accepted on/after 10/16/YY, it is untimely.

The following is an example of an untimely NOE and shows the admission date of 10/10/YY with a receipt date of 10/16/YY.

U5194

When an NOE is untimely, the noncovered days from the admission date to the day before the NOE was received must be reported on the claim with the occurrence span code 77.

NOTE: When the NOE is untimely, the revenue code lines/charges for the noncovered level of care days, (OSC 77), must be submitted as noncovered on FISS Page 02.

U5194

Resources:


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved