tci Medicare Compliance & Reimbursement - 2017 Issue 20

Home Health Reimbursement: OASIS Edits Prompt Returned HH Claims Instead of Denials, MAC Says

Know the 3 necessary steps to resolve 37253 issues. The OASIS edit that took effect in April is killing many agencies' claims, but there is some relief for agencies whose claims run afoul of the edit in error. "Until matching errors are corrected, Medicare systems will Return to Provider (RTP) home health claims when no Outcome and Assessment Information Set (OASIS) is found," HHH Medicare Administrative Contractor Palmetto GBA says in a recent post to its website. Do this: When claims are returned with reason code 37253, the MAC instructs agencies to "use the F9 function to resubmit...

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