Reason Code 15202 - Hospital Inpatient - JF Part A
Reason Code 15202 - Hospital Inpatient
Reason Code Narrative
UNITS OF SERVICE: ON INPATIENT OR SNF CLAIMS WITH COVERED DAYS GREATER THAN ZERO THE ACCOMMODATION DAYS SHOWN WITH REVENUE CODE 10X-21X MUST BE EQUAL TO THE COVERED DAYS IN ITEM 7, AND IN COST REPORT DAYS (PG 1).
Claim without Provider Liable or Free Days
Common Reason Code Errors
- Covered units on revenue code 01X-21X do not match number of covered days in value code 80, or electronic equivalent
- Number of units reflected in revenuecode 01X-21X does not match number of days on claim
Common Reason Code Corrections
- Verify that number of covered units with revenue code 01X-21X are equal to covered days in value code 80, or electronic equivalent
- Covered days should equal total days billed on claim
Note: If patient status is equal to 30, through date of claim must be included in days billed
Fully Covered Claim with Covered Non-Utilization Days (free days)
Common Reason Code Errors
- Free days reflected in 70 Occurrence Span Code (OSC) do not match number of non-covered days in value code 81, or electronic equivalent
- Covered units on revenue code 01X-21X do not match number of total days in value codes 80 and 81, or electronic equivalents
Common Reason Code Corrections
- Free days are reflected as non-covered days in value code 81 or electronic equivalent but units and charges associated with them should be listed as covered on revenue code 01X-21X
Claim with Provider Liable Days Using 77 OSC
Common Reason Code Errors
- Partial provider liable days in 77 OSC are billed with value code 81 or electronic equivalent
-
Number of days reflected in 77 OSC is shown as covered units on revenue code 01X-21X
Common Reason Code Corrections
- Days for provider liability should be billed as covered using value code 80 or electronic equivalent
- Verify number of days reflected with 77 OSC equals provider liable units/charges in revenue code 01X-21X
Resources
- Inpatient Hospital Billing Guide
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3
View reason code list, return to Reason Code Guidance page.
Last Updated Thu, 27 Feb 2020 15:08:12 +0000