Home Health & Hospice Week

Resubmitting the same claim without changing anything won't help.

Autocorrection of the Medicare beneficiary number isn't going to help you when it comes to the OASIS matching edit.

Last October, the Centers for Medicare & Medicaid Services changed the OASIS matching edit to Return to Provider (RTP) claims instead of deny them. CMS hasn't changed back to denying claims outright, but matching edit delays still can be a major drain on cash flow.

One problem: "There are times when a beneficiary's Medicare number is automatically corrected in FISS to match the correct number in the CWF, but the automatic correction does not happen in QIES," warns HHH Medicare Administrative Contractor National Government Services in an article about the edit released last month. "

Solution: "If a Medicare number has been changed (e.g., from a 'B' to a 'D' at the end), the OASIS must be corrected so that QIES will have the correct information," NGS instructs in the article about the 37253 reason code that arises from the edit. "Verify the Medicare number stored in QIES matches the Medicare number on the claim."

Another problem: You can't ignore warnings messages. "QIES will accept an OASIS with minor errors; however, the validation report will have warning messages," NGS says.

Solution: "It is important to pay attention to these warning messages and submit a corrected OASIS to modify the appropriate information required for OASIS-claim match," NGS directs.

"Once the OASIS information has been corrected in QIES, it's important to delete and re-key the 0023 revenue line before resubmitting the RTP claim."