Last Modified: 6/13/2020
Location: FL, PR, USVI
Business: Part A
Q: We are receiving return to provider (RTP) reason code 38119. So what steps can we take to avoid this reason code?
for a description associated with the Medicare Part A reason code(s). Enter a valid reason code into the box and click the submit button.
A: You are receiving this reason code when SNF (skilled nursing facilities) or non-PPS (prospective payment system) inpatient claims are not submitted in the same sequence in which the services are furnished.
• RTP occurs when the SNF inpatient claims are billed “out of sequence”
• SNF claims must be billed sequentially and only after the prior claim has been properly adjudicated
• If your prior claim has not finalized, then wait for the prior claim to finalize before resubmitting this claim
• The claim with this reason code does not directly follow the "through" date of the previous paid claims for this patient from this provider, the "from" date must be the day after the "through" date on the prior bill
• Verify that the “admission date,” "from" date, and patient's Medicare ID on claim(s) to make sure they have been correctly reported
• If admission and "from" dates, as well as patient’s Medicare ID were reported correctly, you must submit prior month's claim
• Prior claim must have processed correctly and appear on your remittance advice (RA) before this claim can be processed. Once prior claim has shown on RA, submit next monthly claim.
• Do not include charges that were billed on an earlier bill
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