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Last Modified: 10/24/2011
Location: FL, PR, USVI
Business: Part A
SNF reason code 38119: Claim out of sequence FAQ
Q: We are receiving return to provider (RTP) reason code 38119, which indicates our skilled nursing facility (SNF) claim is out of sequence. What steps can we take to avoid the claim being returned?
A: You are receiving this reason code because you are submitting your SNF claims before the previous month’s claim has finalized.
For example: Patient is in your facility for the months of January, February, and March.
• You should submit the claim for January in February.
• Once the January claim has finalized, you should submit the February claim (in March).
• Once the February claim has finalized, you should submit the March claim (in April or after the patient has left your facility).
The Centers for Medicare & Medicaid Services (CMS) Internet-only manual (IOM) states:
• If the prior bill has not been finalized, the Medicare administrative contractor (MAC) (formerly the fiscal intermediary) will RTP the incoming bill, request that the prior bill be submitted first, and request that the returned bill only be submitted after the SNF receives notice of adjudication of the prior bill.
• If the prior bill was submitted, the SNF will hold the returned bill until it receives a remittance advice for the prior bill.
Source: CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 6 SNF Inpatient Part A Billing,
Section 40-special inpatient billing instructions (http://www.cms.gov/manuals/downloads/clm104c06.pdf
)
Section 40-special inpatient billing instructions (http://www.cms.gov/manuals/downloads/clm104c06.pdf
)
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