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Last Modified: 2/5/2010 Location: FL, PR, USVI Business: Part A

10416

This is a claim level reject reason code for claims that have all line items rejected by reason code C7251 or C7252.
Tips
The individual reason codes listed for 10416 describe the following:
• C7251 -- for an outpatient claim (12x, 13x, 14x, 22x, 23x, 34x, 74x, 75x, 83x, or 85x) the detail line item date of service is within the admission and discharge date of a skilled nursing facility (SNF) inpatient Part A claim (21x) and a therapy HCPCS code is present. If the detail line item date of service is not present, use the "from and thru" date. When the "from" and "thru" dates are used, the dates may overlap, equal, or be within the posted history inpatient Part A claim (21x).
• C7252 -- for an outpatient claim, the detail line item date of service is within the admission and discharge date of a SNF inpatient Part A claim (21x) for non-therapy services. If the detail line date of service is not present, use the "from and thru" date. When the "from" and "thru" dates are used, the dates may overlap or be within the posted SNF inpatient Part A claim (21x) in history.
A few questions the provider could ask the beneficiary are:
• Have you recently received therapy?
• Are you in a skilled bed in the SNF?
Verify the beneficiary is or is not in a SNF. If the beneficiary is in a SNF, refer to the billing requirements for SNF claims in the Centers for Medicare & Medicaid Services (CMS) Internet Only Manuals (IOM), Publication 100-04, Chapter 6 inpatient Part A billing and SNF consolidated billing external pdf.
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Source: FCSO Education Action Team