Open: Some Home Health Claims Editing for Reason Code 31755

Status: Reason code 31755 was reactivated on January 3, 2023, and returned claims for:

• Billing periods for December 2021 that were opened with a RAP and span into 2022; and 
• Billing period start dates for January 2022 that used the artificial admit date have returned to provider

The date requirements (below) for 31755 may not have been able to be met for the above billing periods. For these billing periods, home health agencies (HHAs) may follow the provider action below. 

For claims that do not meet the above criteria, HHAs need to ensure that: 

• For initial periods of care, the HHA reports on the 0023 revenue code line the date of the first covered visit provided during the period
• For subsequent periods, the HHA reports on the 0023 revenue code the date of the first visit provided during the period, regardless of whether the visit was covered or non-covered

HHAs must correct the dates and resubmit the claims. 

Open

1/11/2023

Status: The issue is in research.    

Provider Action: Home health agencies need to ensure that: 

• For initial periods of care, the HHA reports on the 0023 revenue code line the date of the first covered visit provided during the period
• For subsequent periods, the HHA reports on the 0023 revenue code the date of the first visit provided during the period, regardless of whether the visit was covered or non-covered

Many of the subsequent period claims are reporting the first day of the period rather than the first visit date, which are being correctly returned to the provider. Providers should correct the date and resubmit the claim. See page 61 of Chapter 10: Home Health Agency Billing for more information.

No additional provider action is needed at this time. We will provide an update as soon as it is available.

Some home health claims are being returned for Reason Code 31755. The majority of the claims being returned are provider billing error and need to be corrected with the information provided in the “Provider Action” section of this article. However, Medicare is still receiving claims for January 2022 that used the artificial admit date that have a different 0023 vs. first visit date. We are researching what action to take on these claims.

As of January 3, 2023, reason code 31755 has been reactivated per instructions from the Centers for Mediare & Medicaid Services (CMS). This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim.