Home Health & Hospice Week

Don’t make the mistake of reporting the first day of the billing period instead of the first visit.

If you’re getting claims returned due to the newly turned-back-on 31755 edit, you’re not alone.

“As of January 3, 2023, reason code 31755 has been reactivated per [Centers for Medicare & Medicaid Services] instructions,” HHH Medicare Administrative Contractor CGS says in a recent post on its website. “This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim.”

This is a change from the last couple of years, when that edit was turned off due to Request for Anticipated Payment considerations (see HHHW, Vol. XXXI, No. 45).

Now, “some Home Health (HH) claims are being returned to providers (RTP) due to billing errors,” says HHH MAC National Government Services in a message to providers.

“There are some problems this January with reactivation of reason code 31755,” agrees consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. Warmack has heard from more than one provider “getting claim payment denied because of this reason code,” Warmack tells AAPC.

“The majority of the claims being returned are provider billing error and need to be corrected,” instructs HHH MAC Palmetto GBA in its Claims Payment Issues Log.

Do this: “Enter the date of the first covered visit during the period with Revenue Code 0023,” NGS directs. “For subsequent periods, providers are advised to report the date of the first visit during the period, regardless of whether the visit was covered or noncovered.”

Common problem: “Many of the subsequent period claims are reporting the first day of the period rather than the first visit date, which are being correctly returned to the provider,” Palmetto explains. “Providers should correct the date and resubmit the claim,” the MAC says.

An exception is for claims from a year ago, January 2022. “Medicare is still receiving claims for January 2022 that used an artificial admission date, causing the claims to RTP with RC 31755,” NGS reports.

“We are researching what action to take on these claims,” Palmetto says.

Note: See the MAC communications about the 31755 issue at www.palmettogba.com/palmetto/jmhhh.nsf/DID/ G1SEK2D3I9, www.ngsmedicare.com/web/ngs/production-alert-details?alertid=5235184, and https://cgsmedicare.com/hhh/pubs/ news/2023/01/cope133569.html.