Resolution Tips for Overlapping Claims
A/B & HHH MAC Collaborative Job Aid for Overlapping Claims |
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Introduction |
This article is intended to assist providers that experience claim rejections for overlapping dates of service. The information contained in this article is designed to give providers tips that can be used to resolve an overlapping billing situation and avoid future overlapping situations. Overlapping situations can occur for any number of reasons. This article contains information on the most common reasons for which an overlapping situation can occur. |
Types of Bills (TOBs) Impacted |
The overlapping situations may apply to TOBs:
11X 72X 81X
13X 74X 82X
21X 75X 85X
32X
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Overlapping Situations |
An overlapping situation may occur between hospitals for inpatient stays, which include Inpatient Psychiatric Hospitals (IPH), Long Term Care Hospitals (LTCH), Inpatient Rehab Facilities (IRF), Critical Access Hospital (CAH)], hospitals for outpatient services, Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), Hospice agencies, Outpatient Rehab Facilities (ORF), Comprehensive Outpatient Rehab Facilities (CORF), End Stage Renal Disease (ESRD) Facilities, or a combination of one provider type and another. |
Resolutions Tips for All Provider Types |
Medicare providers are expected to verify a beneficiary’s Medicare eligibility at the time of or prior to admission to ensure that the patient is eligible to receive the services covered by Medicare. Checking the beneficiary’s eligibility records also ensures that the facility/agency verifies whether or not the patient is receiving services from another entity that would cause an overlapping situation. |
Please select one of the topics below to view specific facility information. |
Resolution Tips for Inpatient Hospitals |
Hospital Transfer Situation
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Resolution Tips for Outpatient Hospitals |
Hospital Outpatient Overlapping Hospital Inpatient Including Acute, IRF, IPF, and LTCH |
Resolution Tips for SNFs |
SNF Transfer Situations |
Resolution Tips for ESRD Facilities |
ESRD Overlapping with an Inpatient Hospital |
Resolution Tips for Home Health Agencies (HHAs) |
Home Health Transfer Situations
The transferring agency is required to document the following:
Home Health Overlapping Inpatient Hospital or SNF Part A Stay |
Resolution Tips For Outpatient Rehab Facilities and Comprehensive Outpatient Rehab Facilities |
ORF or CORF Overlapping with SNF |
Resolutions Tips For All Provider Type Overlapping a Hospice |
Providers of all types whose claims are overlapping a hospice election should contact the Hospice agency to determine if the services are related to the terminal illness. If related, payment arrangements should be made with the hospice provider. Services that are not related to the terminal illness should be billed with a 07 Condition Code. Reference: CMS IOM Pub. 100-04, Chapter 11, Section 30.3 (PDF, 464 KB). |
Resolution Tips for Hospices |
Hospice Transfer Situations |