|
Last Modified: 4/6/2011
Location: FL, PR, USVI
Business: Part A
15202
On inpatient (type of bill (TOB) 11x or 18x) or skilled nursing facility (SNF) (TOB 21x) claims, a discrepancy exists between the covered days billed and the covered accommodation units billed.
Important Note: accommodation units are recognized as revenue codes 010x-021x, excluding 018x (leave of absence) and 019x (sub-acute care).
Resources/tips to avoid or correct this return to provider (RTP) claim
Verify the covered days and that the accommodation unit/revenue code lines are billed appropriately. Examples of billing issues include:
• Non-covered, or
• Revenue code 018x or 019x are not counted as covered, or
• A line level edit has assigned on the accommodation unit/revenue code line
• Days billed do not match accommodation unit/revenue code and charges are billed as non-covered. (An exception to this rule for TOB 11x would be when an occurrence span code 70 is present due to cost outlier situation)
• Non-covered days are present and only accommodation unit/revenue code lines have been billed as non-covered. Ancillary charges for non-covered days should be billed as non-covered
• Outpatient claims should not be billed with days and/or accommodation unit/revenue codes
Recommendations:
• If a correction is required to the accommodation units/revenue code line, you will have to delete the entire line and re-key the line before resubmitting the claim. This will ensure any prior reason code assigned on this line is removed.
on the 'ELGA' (eligibility A) screen.• If you submitted an outpatient claim, delete days and/or accommodation units/revenue code lines before resubmitting the claim.
To correct this RTP, make the necessary corrections and resubmit the claim.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
