tci Medicare Compliance & Reimbursement - 2016 Issue 16

Industry Note: Medicare Claims System Fix On Deck

A claims system correction should clear up returned and held claims due to an error in the July system update. The problem:The Centers for Medicare & Medicaid Services (CMS) has identified two glitches, Home Health & Hospice Medicare Administrative Contractor Palmetto GBA reports: Reason Code 31698 (Claims with a Type Of Bill [TOB] equal to 322 or any TOB other than 32x with Condition Code 54) is set to Return to Provider (RTP); and Reason Code 31699 (Claims with a TOB 32x other than 322, from date not equal to admission date, Revenue Code 42x, 43x, 44x or 55x...

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