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Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code U5194

Description:

The occurrence span code (OSC) 77 is missing or the dates are incorrect.

Resolution:

The hospice notice of election (NOE) must be received within 5 calendar days after the effective date of the hospice election. When the NOE is not received timely, Medicare will not cover/pay for days of care from the admission date to the date the NOE was submitted/accepted. OSC 77 must be reported to identify the dates from the date of admission to the date before the NOE was received.

Use FISS Option 12 to determine the date CGS received the NOE.

Example of timely/untimely NOE calculation:

  • Admission date = 10/10/YY
  • Day 1 = 10/11/YY
  • Day 2 = 10/12/YY
  • Day 3 = 10/13/YY
  • Day 4 = 10/14/YY
  • Day 5 = 10/15/YY (This is the NOE "due date")

If the NOE is received and accepted on/after 10/16/YY, it is untimely.

The following is an example of an untimely NOE and shows the admission date of 10/10/YY with a receipt date of 10/16/YY.

U5194

When an NOE is untimely, the noncovered days from the admission date to the day before the NOE was received must be reported on the claim with the occurrence span code 77.

NOTE: When the NOE is untimely, the revenue code lines/charges for the noncovered level of care days, (OSC 77), must be submitted as noncovered on FISS Page 02.

U5194

Resources:

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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