I just called on this yesterday.  They told me it had nothing to do with Medicare, but with the qies system.  I printed out the QIES approved SOC and EOE and am appealing.

Hi Everyone –

I’m wondering if anyone else is experiencing this issue: three of my Final claims (PPS and PDGM) have RTP’d for reason 37253, and when I call Medicare they tell me the problem is that the Final claim was received outside the 40 days since the start of care or recert OASIS was transmitted. One person I spoke to at Medicare said this was a new thing that somehow everyone missed. It has only happened for me with claims for OASISes that I submitted via iQies.

I certainly didn’t see anything from either Medicare or iQies about the Final claim needing to be received within 40 days of the OASIS transmission date -- seems like that is something that would have been broadly discussed throughout the industry as it seems like an unrealistic expectation to me (especially for PPS episodes!). Another of the Medicare reps actually said it was better if providers waited until the end of the 30 day SOC OASIS submission deadline to submit SOC OASISes, as that would allow a time buffer to get orders, etc, back in time to send the Final within 40 days – I see his point if this is a legitimate deadline, but the whole thing seems pretty sketchy to me so I thought I would get some input from the hive mind!

Thanks!

Kori Meyer

Biller | Pathways to Achievement, Inc

114 S 20th Ave W Suite A | Duluth  MN  55806

218.623.7106 | Fax 218.491.7185