Critical access hospitals (CAHs) professional claims line-item date of service (LIDOS) with revenue codes 096X, 097X and 098X are being denied (status D) for not having physician reassignments on file

Issue

To prevent duplicate billing of professional claims from CAHs and professional physician services, CMS implemented editing with change request (CR) 13900 CR13900 created reason codes 31006 and 31007 to ensure reassignment information was on file when CAH claims are submitted containing professional services (revenue codes 096X, 097X and 098X). 

It has been discovered that many providers do not have a reassignment application on file in the Provider Enrollment, Chain, and Ownership System (PECOS). If the rendering or attending physician has not reassigned their benefits to the CAH in PECOS, then these edits will set on the professional service lines of a CAH claim. 

Resolution

CMS has instructed the MACs to temporarily deactivate reason codes 31006 and 31007. CAHs claims that denied with these reason codes will be reprocessed.

Status

Open

Provider action

Providers should take this opportunity to review their enrollment records and submit physician reassignment applications if necessary. Individual practitioners must complete and submit the CMS-855I form to reassign their billing rights to the CAH. The CAH must forward a copy of the CMS-855I to the Part B MAC. The practitioner must sign an attestation that clearly states the practitioner will not bill the Part B MAC for any services rendered at the CAH once reassigned to the CAH. The attestation will remain with the CAH.

Review the Temporarily deactivating reason codes 31006 and 31007 for CAH method II claims article and the CMS Information for Critical Access Hospitals for additional information. 

Current processing issues

Here is a link to a table of current processing issues for both Part A and Part B.