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Printed Date: 9/22/2015
Part A - An outpatient or home health claim has dates of service that equal, overlap or are within the From/Thru dates of an inpatient claim and the provider number is different.
Explanation and Suggestion:
Review the dates of service on the outpatient or home health claim. Determine which date overlaps the inpatient stay by reviewing the Common Working File (CWF), the HIPAA Eligibility Transaction System (HETS) or the eServices portal Inpatient tab.
Please be aware that the DOEBA and DOLBA dates reflect the first and last billing dates in an inpatient benefit period, and the beneficiary may have had multiple inpatient stays during a single inpatient benefit period.
Part A Tip: If dates of service are correct and provider is billing a repetitive claim (e.g., ESRD) please be sure to use occurrence span code 74 with the inpatient dates of service.
Home Health Tip: Use the date of the first Medicare billable visit in the episode as the date of service for revenue code 027X or 0623 when billing non-routine or surgical dressing/wound care supplies.
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Last Updated: 12/27/2018