Reason Code 37253

Published 01/11/2022

Description
This reason code is assigned when there is no corresponding OASIS assessment found in Medicare’s systems related to the claim.

Resolution
Before submitting your claim and the OASIS assessment, ensure the following OASIS items are correct. These items are used to match the claim with the OASIS assessment.

  • Home health agency (HHA) Certification Number (OASIS item M0010)
  • Beneficiary Medicare Number (OASIS item M0063)
  • Assessment Completion Date (OASIS item M0090)
  • Reason for Assessment (OASIS Item M0100) equal to 01, 03 or 04

In addition, before submitting the final claim, it is important that you ensure the OASIS assessment has completed processing and was successfully accepted into the Quality Information and Evaluation System (QIES) National Database. Verify this by reviewing the OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the submission which included the assessment. These reports will provide information that confirms the assessment's receipt, the date of receipt, and any fatal or warning errors encountered.

If your claim is in the Return to Provider (RTP) file (T B9997), review the OASIS and claim and correct any errors to ensure they match.

Note: Before you resubmit (F9) the claim out of the RTP file, be sure to take the following action.

Delete the 0023 Revenue Code Line

  • Key the letter "D" in the first position of the 0023 revenue code
  • Press the Home key on your keyboard so that your cursor is placed in the upper right-hand corner of the screen (the Page field)
  • Press Enter. The revenue code line(s) with the letter "D" will be removed, and FISS will automatically reorder the remaining revenue code lines

To Add the 0023 Revenue Code Line

  • Re-key the same 0023 revenue code line information that was deleted under the 0001 revenue code line
  • Press the Home key on your keyboard so that your cursor is placed in the upper right-hand corner of the screen (the Page field)
  • Press Enter and FISS will automatically reorder the revenue code lines
  • Press F9 to allow the claim to continue processing

If you believe there are no errors and the OASIS was successfully accepted into the QIES database, please contact QIES.

If there is no error and it is determined the claim did not meet the condition of payment, submit a claim for denial using the following coding elements:

  • Type of bill 0320, which indicates the expectation of a full denial
  • Occurrence Span Code 77 with span dates matching the “From” and ”Through” dates of the claim to indicate acknowledgement of liability for the billing period
  • Condition Code D2 indicating the change in billing the HIPPS code to non-covered
  • Condition Code 20
  • Do not use condition code 21

References


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