Medicare Compliance & Reimbursement

Know the 3 necessary steps to resolve 37253 issues.

The OASIS edit that took effect in April is killing many agencies' claims, but there is some relief for agencies whose claims run afoul of the edit in error.

"Until matching errors are corrected, Medicare systems will Return to Provider (RTP) home health claims when no Outcome and Assessment Information Set (OASIS) is found," HHH Medicare Administrative Contractor Palmetto GBA says in a recent post to its website.

Do this: When claims are returned with reason code 37253, the MAC instructs agencies to "use the F9 function to resubmit your claim after taking one of theseactions:

• Update the Health Insurance Claim (HIC) number on the OASIS assessment to match the current information
• Correct the assessment completion date reported in the claim treatment authorization code to match the OASIS assessment
• Resubmit for denial using condition code 21 and Type of Bill 320 if the assessment was not submitted."

The returns instead of denials started for claims received Oct. 6, Palmetto says in a separate post running over more details of the matching problems.

For example: "If OASIS item M0063 is left blank when the OASIS is transmitted, the QIES will accept the OASIS and will not generate a warning message. However, when the final/end of episode claim is submitted, the system will be unable to locate a corresponding OASIS, which will result in the claim being RTP," Palmetto explains in the post updated Oct.  10.

Solution: "A corrected/modified OASIS should be submitted/transmitted to QIES before the final claim is submitted to Medicare. If the claim is RTP, submit a corrected OASIS before retransmitting the claim," the MAC explains.

Note: The article, which contains multiple illustrative scenarios, is at www.palmettogba.com - click on "Jurisdiction M Home Health and Hospice" in the blue box; then click on "Job Aids" in the green "Top Links" box and scroll down to the Oct. 10 entry "Understanding Reason Code 37253 on Home Health Claims" link.