15202

When this reason code is received on an inpatient hospital or inpatient Skilled Nursing Facility (SNF) claim (TOB 11x, 21X or 18x), it typically means that a discrepancy exists between the covered days billed and the covered accommodation units billed.

Important Note
Accommodation units are recognized as revenue codes 010x-021x, excluding 018x (leave of absence) and 019x (sub-acute care).

Resources and Tips to Avoid or Correct RTP Claim
Verify the covered days and that the accommodation unit/revenue code lines are billed appropriately. Examples of billing issues include:

  • Non-covered
  • Revenue code 018x or 019x are not counted as covered
  • A line level edit has assigned on the accommodation unit/revenue code line
  • Days billed do not match accommodation unit/revenue code and charges are billed as non-covered. An exception to this rule for TOB 11x would be when an occurrence span code 70 is present due to cost outlier situation.
  • Non-covered days are present and only accommodation unit/revenue code lines have been billed as non-covered. Ancillary charges for non-covered days should be billed as non-covered.
  • Outpatient claims should not be billed with days and/or accommodation unit/revenue codes

SNF Specific Resources and Tips:

  • All revenue code 0022 units must match the accommodation units/revenue codes
  • If reporting a leave of absence with occurrence span code (OSC) 74; must report revenue code 0180 days without charges. The OSC 74 dates must reflect the days the patient was absence at midnight from the SNF and match the 0180 unit count.
  • When billing with a 30 patient status code; count the day/units as covered
  • When reporting lower level of care (occurrence code 22); count the day/units. Please note: that the date the patient moves to a lower level of care, is the Through date of that claim. The following claim(s) are billed according to: Section 40.9 - Other Billing Situations (PDF, 488 KB).
  • If applicable, refer to Section 40.8 Billing in Benefits Exhaust and No Payment Situations (PDF, 488 KB)

Recommendations:

  • If a correction is required to the accommodation units/revenue code line, you will have to delete the entire line and re-key the line before resubmitting the claim. This will ensure any prior reason code assigned on this line is removed.
  • Review the days available in direct data entry (DDE) on the 'ELGA' (eligibility A) screen
  • If you submitted an outpatient claim, delete days and/or accommodation units/revenue code lines before resubmitting the claim

To correct the RTP claim, make the necessary corrections and resubmit the claim.

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