31090

FISS Narrative
On an inpatient or SNF claim, the covered day count is equal to zero, but covered charges are greater than zero.

Explanation and Suggestion
Reason Code 31090 indicates that on an inpatient or Skilled Nursing Facility claim, the covered day count = zero, but total covered charges are greater than zero. Providers should be aware as to when to use occurrence span code (OSC) M1 versus OSC 77.

  • Occurrence Span Code M1: Provider Liability – No Utilization
    The From/Through dates of a period of non-covered care that is denied due to lack of medical necessity or as custodial care for which the provider is liable. The beneficiary is not charged with utilization. The provider may not collect Part A or Part B deductible or coinsurance from the beneficiary. Please refer to the revised MLN Matters® Number: SE1333 (PDF, 116 KB).
  • Occurrence Span Code 77: Provider Liability – Utilization Charged
    The From/Through dates for a period of non-covered care for which the provider is liable (other than for lack of medical necessity or as custodial care). The beneficiary’s record is charged with Part A days, Part A or Part B deductible, and Part B coinsurance. The provider may collect Part A or Part B deductible and coinsurance from the beneficiary. Please refer to CMS IOM 100-4, Chapter 3 , (PDF, 2 MB) Section 40.1, F. Provider Liability Issues.

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