- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Reason Code 39929
- Influenza and Pneumonia Vaccinations in the Home Health and/or Hospice Setting
- Certification or Recertification of Medicare Covered Home Health Services
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- MLN Matters® 11855 Request for Anticipated Payment Submission Frequently Asked Questions
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Counting 60-Day Episodes
- Notice of Admission Questions and Answers
- Home Health Patient-Driven Groupings Model (PDGM) FAQs
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Requests for Anticipated Payment
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Episodes with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- Correcting and Avoiding Overlap Reason Codes
- 30-Day Home Health Therapy Reassessment Schedule
Correcting and Avoiding Overlap Reason Codes
Table of Contents
- Correcting and Avoiding Overlap Reason Codes
- Provider Action Steps
- How to Avoid This Reason Code
- Related Content
Correcting and Avoiding Overlap Reason Codes
Three common error codes are applied to home health RAPs and claims. The three reason codes have one major commonality—they point to an overlap with an existing home health episode. This overlap can be with another HHA or your own agency. The three high-volume home health overlap error codes and their descriptions are:
- U538I: The RAP or episode claim overlaps an existing episode with a different provider
- U538F: The RAP or episode claim overlaps an existing episode at your agency and the from date equals the episode’s start date
- U538G: The RAP or episode claim overlaps an existing episode at your agency and the from date is different than the episode’s start date
Provider Action Steps
- Check the CWF for the presence of an established home health episode.
- Contact the HHA with the open episode to verify the transfer. (Note: Please refer to the home health Transfer Job Aid for proper transfer protocol.)
- Verify the dates and codes billed on your RAPclaim.
| IF… | THEN… |
|---|---|
| The patient was transferred to your agency | Enter condition code 47 to indicate patient transfer for dates of service on or after 7/1/2010. Use admission source code ‘B’ on your transfer RAP if for date of service prior to 7/1/2010. |
| The patient was discharged and readmitted to your agency in the same episode | Verify episode start date and previous episode end date. Use admission source code ‘C’ on the readmission RAP for dates of service prior to 7/1/2010. |
| The RAPclaim is for an initial episode | The “From” date needs to be the same as the admit date |
| The RAPclaim is for a subsequent episode | The “From” date needs to reflect the date the subsequent episode began (day 61, 121, 181, etc.) |
How to Avoid This Reason Code
- Always check the CWF when accepting a new patient to ensure no other HHA has been established as the primary agency.
- Talk to the beneficiary about any other care they are receiving in the home.
- Verify the dates billed and coding on your current claim submission and previous episode claims.
- Develop an internal process or checklist of systems/information that must be confirmed before submitting claims to Medicare.