Medicare Compliance & Reimbursement
Medicare Claims System Fix On Deck
A claims system correction should clear up returned and held claims due to an error in the July system update.
The problem: The Centers for Medicare & Medicaid Services (CMS) has identified two glitches, Home Health & Hospice Medicare Administrative Contractor Palmetto GBA reports: Reason Code 31698 (Claims with a Type Of Bill [TOB] equal to 322 or any TOB other than 32x with Condition Code 54) is set to Return to Provider (RTP); and Reason Code 31699 (Claims with a TOB 32x other than 322, from date not equal to admission date, Revenue Code 42x, 43x, 44x or 55x not present and Condition Codes 20, 21, or 54) is also set to RTP.
MAC CGS also reports numerous provider calls in relation to 31699.
The solution: An Aug. 8 fix is scheduled, Palmetto reports. If you’ve had a claim returned under this error, you can resubmit it and it will be held and released when the correction is verified.
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