Reason code 39910 causes claims to suspend when the provider reimbursement amount is equal to zero. Reason code 37187 is the finalized claim edit that indicates the claim has completed processing and no additional payment can be made.
These reason codes are most commonly received when the Medicare deductible amount matches the full payment amount on the claim. When no reimbursement is made to the provider due to the Medicare deductible, no Medicare payment will be issued to the provider.
These reason codes can also indicate that a billing error was made. When a claim is submitted with certain invalid or missing information, it can result in the claim receiving a zero dollar reimbursement amount. We encourage providers to confirm that their billing is correct.
Some common billing scenarios that may result in a zero dollar reimbursement:
All Providers/Type of Bills (TOB)
Revenue Code and the Healthcare Common Procedure Coding System (HCPCS) combination- Ensure that the HCPCS billed is reported on the appropriate Revenue Code type.
For Direct Data Entry (DDE) users- A shortcut (SC) is available that will assist providers with allowable HCPCS/Revenue combinations. Select SC 14 in DDE to view the HCPCS file and view allowable revenue code types. This SC is not all inclusive, additional resources may be utilized to determine appropriate billing, such as the Internet Only Manuals, The Centers for Medicare & Medicaid Services website, etc.
Outpatient Claims (TOB 13x)
Payable services are denied for a reason such as Medically Unlikely Edits (MUE) and only services that remain not denied are Status ‘N’ codes- Review line item denials on claims.
The definition of Status ‘N’- packaged item or service
Laboratory Services- Confirm that the HCPCS is submitted on a valid Revenue Code type, appropriate modifiers are submitted and any primary laboratory HCPCS are submitted that may be necessary.
Inpatient Claims (TOB 11x)
Ensure the appropriate value codes are submitted to account for the days that are submitted on the claim, both covered and non-covered. Verify the beneficiary eligibility to determine number of days to bill.
Value Code 80- Covered Days
Note: This will include any full covered days, co-insurance days and Lifetime Reserve days as a grand total. Value Codes 82 and 83 will still be needed if that type of day is being utilized.
Value Code 81- Non-Covered Days
Value Code 82- Co-insurance Days
Value Code 83- Lifetime Reserve Days
Rural Health Clinics (TOB 71x) and Federally Qualified Health Centers (TOB 77x)
Ensure there is a valid qualifying visit/encounter visit billed on the appropriate revenue code.
Revenue Code Definition
0521- Clinic visit by member to RHC/FQHC
0522- Home visit by RHC/FQHC practitioner
0524- Visit by RHC/FQHC practitioner to a member in a covered Part A stay at a Skilled Nursing Facility (SNF)
0525- Visit by RHC/FQHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility
0527- RHC/FQHC Visiting Nurse Service(s) to a member’s home when in a Home Health Shortage Area
0528- Visit by RHC/FQHC practitioner to other non RHC/FQHC site (e.g., scene of accident)
End Stage Renal Disease Facilities (TOB 72x)
Payable services are denied for a reason such as overlap and only services that remain not denied are Status ‘N’ codes- Review line item denials on claims.
The definition of Status ‘N’- packaged item or service.
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