Reactivating Reason Code 31755
As of 1/3/2023, reason code 31755 was reactivated per CMS instructions. This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim. Please read below for further explanation.
CR 11855 implemented a penalty for delayed submission of home health RAPs applicable to Original Medicare RAPs and claims with “From” dates on or after 1/1/2021. To allow for the prompt submission of RAPs, Medicare revised home health billing instructions to allow submission of:
- Future dated RAPs
- RAPs for second and later periods of care before the first visit in the period is provided
In either case, Medicare instructed providers to report the first day of the period of care as the revenue code 0023 line-item date of service on the RAP.
The FISS reason code 31755 requires the revenue code 0023 line-item date of service to match the date of service of a home health visit. Frequently, the first visit of a period of continuing care does not occur on the first day of the period. To allow providers to exercise the flexibility provided by the CR 11855 billing instructions above, MACs deactivated reason code 31755 in January 2021.
In January 2023, the timely filing period for home health periods of care furnished in 2021 will be over. In addition, a one-time home health NOA replaced the submission of RAPs in 2022. Since the CR 11855 RAP submission instructions no longer apply, CMS instructed MAC to reactivate reason code 31755 when the January 2023 release was implemented on 1/3/2023.
Home health agencies need to ensure that:
- For initial periods of care, the HHA reports the date of the first covered visit provided during the period on the 0023 revenue code line
- For subsequent periods, the HHA reports the date of the first visit provided during the period, regardless of whether the visit was covered or non-covered, on the 0023 revenue code line
Posted 6/15/2023