Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates. This week, Melinda highlights the most recent clarification for Medicare Home Health Billing of Final Claims in 2021.
This past week CMS issued breaking information regarding the 38107 and U5391 reason codes for your claims going into return to provider or T-Status. When those claims go to 38107, it has always been the case that it’s there because something doesn’t match between the final claim and the request for anticipated payment (RAP) that was previously filed. Those items include the patient information, the start of care date, the from date on the RAP and the final, the HIPPS code itself, and the service date.
So the first billable visit date. So when we moved into 2021 with a no pay RAP situation and the five-day timely filing requirement, it was made very clear that you are to use the first day of the 30 day period to build your RAPs as the first billable visit date so that you can meet the five-day timely filing requirement. However, there was some very confusing information in the claims processing manual updates that led everyone to believe that the final claim had to continue to have the exact information that was applicable to that claim, including that the first billable visit date on the HIPPS code line had to match the actual first billable visit date on the final claim.
We have since learned that is not the case. And that you must list of course all the visits that are considered covered visits in the detail of the visits. But the first billable visit date on the HIPPS code line does have to match the first billable visit date on the HIPPS code line on the request for anticipated payment or the RAP.
So if you have claims today that are in return to provider status (T-status) because there is a different date on the final claim on the HIPPS code line than there is on the RAP. You simply need to change the service date or first billable visit date on the HIPPS code line to match the date on the RAP, release that final claim, and those will pay.
CMS has issued this clarification this past week, the week of February 15. The Medicare MAC’s have begun updating their websites but the claims are processing and paying when the service dates match between the RAPs and the final claim. Even when the first billable visit date of the actual visit on the final claim doesn’t match that HIPPS code line. They have removed the edit from the final claims to require the service date on the HIPPS code line to match that first billable visit.
So hopefully this has helped clarify why some of your clients might be in T status. Again, this applies to reasons codes 38107 and U5391. Feel free to give us a call or send us an email if you have any additional questions.