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Home Health & Hospice Week

Industry Note:

Troubleshoot 31503 Claim Returns With This New Tool

Published on Thu Mar 22, 2012

You can tap a new tool from HHH MAC CGS to help with a common hospice claim error. Problem: "Hospice claims are often sent to the Return to Provider (RTP) file with reason code 31503 when the total units on the level of care lines do not equal the number of days in the billing period," CGS notes in an e-mail to providers. Solution: "Ensure the total the number of days (i.e. units) for the level of care lines equals the number of days indicated by the FROM and TO date on the claim," CGS advises on a new website page aiming to help hospices resolve the problem. Tip: For continuous home care, each 0652 revenue code line is equivalent to one day of care, regardless of the units billed on the 0652 line.- Examples of how to count the days and units are on CGS's page at www.cgsmedicare.com/hhh/education/materials/31503.html.
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