Home Health & Hospice Week

Yet another glitch is affecting the processing of no-pay Requests for Anticipated Payment and related claims.

The problem: Claims may be inappropriately returning with Reason Code U5391, HHH Medicare Administrative Contractor Palmetto GBA says in its claims processing issues log. The code indicates that one of the following fields on the final (TOB 329 or 339) do not match to the RAP: 1) statement “from” date, 2) admission date, 3) HIPPS code, 4) line item date for the HIPPS code (0023 revenue line date), and 5) provider number.

“This issue may be caused by the CY 2021 changes in MLN 11855, which allows line item date for the HIPPS code to be the first day of the period of care as the service date on the 0023 line,” Palmetto explains on its website. In other words, the change that allows home health agencies to bill a no-pay RAP for a second 30-day billing period at the same time as the RAP for the first 30-day period could be involved.

The solution: “If a RAP has processed, ensure the statement ‘from’ date, admission date, HIPPS code, line item date for the HIPPS code (if not reporting the first day of the period on the RAP in CY 2021) and provider number on the claim match the RAP,” Palmetto instructs. “No provider action is necessary at this time. We will provide updates when applicable.”