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Home Health & Hospice Week

Industry Note:

Edits Checking Type Of Admission Codes Reactivated

Published on Wed Apr 27, 2011

Type of admission codes are giving hospices more headaches, but the issues soon should be resolved. The problem: "Providers are receiving reason code 11801 but were not able to access the DDE field to make the necessary corrections. Such claims returned to provider (RTP'd) for correction and are in suspense status location SMPRZ" with HHH MAC NHIC, the Medicare contractor reports in an e-mail message to providers. The solution: The claims system problem was resolved and the edit was reactivated May 9, NHIC reports. "Claims are now receiving reason code 11801 correctly," it says. The affected claims will RTP and hospices should add the appropriate type of admission code and resubmit. Remember, the type of admission codes now required on claims are 1 (emergency), 2 (urgent), 3 (elective), 4 (newborn), 5 (trauma), and 9 (information not available). Providers should use "9" if they're not sure what applies, CMS said earlier [...]
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