Know most common RTP codes to avoid costly errors
Understanding why claims are returned to providers for correction will help home health staff members better check claims before they are submitted, says Terry Cichon, CPA, director of homecare operations for FR&R Healthcare Consulting in Deerfield, IL. The most common return-to-provider reason codes are:
• Reason Code 38107/Causes for return:
— A final claim has been submitted, but no request for anticipated payment (RAP) exists.
— A RAP exists, but the final claim doesn’t match one or more of these fields on the UB92.
• Reason code 30720/Cause for return:
— Outcomes and Assessment Information Set (OASIS) matching key is missing from the RAP or final claim (Field 63 on the UB92).
• Reason code 31018/Causes for return:
— Final claim is submitted for less than 60 days, but patient status code is 30 in field 22 of the UB92.
— Statement covers period is for more than 60 days.
• Reason code 32907/Cause for return:
— Line item date is not within the from and through dates of the claim.
• Reason code 11801/Cause for return:
— Source of admission (field 20 on UB92) is not on the RAP or final claim.
• Reason code 31755/Causes for return:
— The admission date of the claim is equal to the statement from date; the date of the revenue code 0023 also should match.
— Revenue code 0023 was not found.
— The 0023 service date must equal a visit date.
• Reason code 30715/Cause for return:
— The patient last name and/or first initial on the claim does not match the beneficiary record.
• Reason code 12100/Causes for return:
— Patient status on RAP is not 30.
— Patient status on final claim is invalid.
• Reason code W0452/Cause for return:
— Primary diagnosis code is invalid.
• Reason code W0453/Cause for return:
— 2nd diagnosis code is invalid.
• Reason code W0454/Causes for return:
— 3rd diagnosis code is invalid.
— Date shown is the first day of the next certification period.
Understanding why claims are returned to providers for correction will help home health staff members better check claims before they are submitted, says Terry Cichon, CPA, director of homecare operations for FR&R Healthcare Consulting in Deerfield, IL.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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