Reason Code 12205 - JE Part A

Reason Code Narrative

STATEMENT COVERS PERIOD: OUTPATIENT BILL TYPES 12-14X, 22-24X, 13X, 43X, 71-72X, 74X, 75X, 83X, AND 85X MUST INSURE THAT THE FROM AND THRU DATES USED TO REFLECT THE DATES OF THE FIRST AND LAST SERVICE ARE IN THE SAME CALENDAR YEAR.

Common Reason Code Errors

• An outpatient claim was submitted with a ‘from' and ‘through' date that overlaps the calendar year end.

Note: Medicare outpatient deductible and coinsurance amounts are based off of the calendar year.

Common Reason Code Corrections

• When the "From" and "Through" years are different, submit a separate claim for each year. (Also known as split-billing).

Note: When split billing a claim, make sure that the claim for the first calendar year processes and finalizes before submitting the claim for the second calendar year.

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 70.8.1

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