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Medicare News Update Medicare Information Resource
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MIR-2006-11A, November 2006
Skilled Nursing Facility (SNF) Continuing Stay Claims Reason Codes 38118 and 38119
Provider types affected
Skilled nursing facilities that bill Medicare fiscal intermediaries (FIs) for skilled nursing care benefits
Background
SNFs are required to bill monthly for a beneficiary that meets the technical and medical qualifications for Medicare coverage. When a beneficiary has not left your facility, these claims are considered continuing stay claims. All continuing stay claims within the same admission should be coded with the same admission date and submitted in sequential order. Because these are continuing stay claims, you cannot submit the next claim in the sequence until the previous claim has posted to the Common Working File (CWF). Therefore, you should not submit the next claim in the sequence until you have received confirmation from your FI, via remittance advice, that the prior claim has processed.
From March 2006 to August 2006, there were 5,071 SNF claims that were returned to provider (RTP) with reason code 38118 and 10,575 SNF claims that were RTP with reason code 38119.
Reason Codes
| 38118 |
This is a continuing stay non-PPS claim. The prior claim is pending but not yet finalized. Resubmit this claim after you have received the remittance advice for the prior claim. |
The prior claim must finish processing before you can submit the next claim in the sequence. Submitting all claims within an admission at once will result with all but the admission claim receiving this reason code.
| 38119 |
This is a continuing stay claim but there is no record of the prior processed claim. Verify Health Insurance Claim (HIC), admission date, from date and through date. Submit the prior claim(s) and resubmit this claim after you have received the remittance advice for the prior claim. |
In this case, the system cannot find the prior processed claim in the sequence. There are two reasons this may happen.
- The prior claim was not submitted or it was submitted and was returned to you with errors.
- The prior claim has processed, but either the prior claim or the claim in question is coded with an invalid admission date. Always verify that the admission date is the same for all claims within the same admission.
Please note that when a beneficiary is discharged from your facility but is readmitted, the new admit date will be the date the beneficiary was readmitted
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