Reason Code U537F

Description
A Home Health (HH) Notice of Admission (NOA) overlaps an existing HH admission.

Reason Code U537F will assign correctly when:

• There is an open admission period on file (Patient Status 30) from a different home health agency in 2022 or later and Condition Code (CC) 47 was not applied
• Duplicate NOAs were submitted (same beneficiary, admission date, provider, etc.)
  • In this scenario, one of the two NOAs is usually returned with U537F
• New NOA is submitted when a patient readmits to the same HHA in the same 30-day period that they were discharged because of admissions to other provider types (i.e., hospitals, skilled nursing facilities)
  • If an agency chooses to discharge, based on an expectation that the beneficiary will not return, but does return to them in the same period, the discharge is not recognized for Medicare payment purposes
  • All the HH services provided in the complete period of care, both before and after the inpatient stay, should be billed on one claim
  • More information on this topic is available in the Medicare Claims Processing Manual Medicare Claims Processing Manual (Publication 100-04, Chapter 10 (PDF), Section 10.1.14 - Discharge and Readmission Situation Under HH PPS - Payment Effects)

Resolution

• Overlap of another HH admission: add CC 47 to your NOA if there is an open admission period on file (Patient Status 30) from another home health agency (HHA) in 2022 or later and the beneficiary has been discharged from the other HHA, but the final claim has not been submitted or processed at the time of the new admission 
• If duplicate NOAs were submitted, verify if one of the NOAs processed and opened the HH admission. If so, no additional action is necessary. If neither NOAs processed, resubmit one NOA for the admission. 
• If the NOA was returned because the patient readmits to the same HHA in the same 30-day period that they were discharged because of admissions to other provider types (i.e., hospitals, skilled nursing facilities), adjust the discharge claim and bill services both before and after the inpatient stay on one claim and make other necessary changes to the claim, such as updating the Patient Status code