Reason Code C7080

Revise
Reason Code C7080

Description
A line item date of service (LIDOS) submitted on a home health claim overlaps a date of service on an inpatient claim. Per the Medicare Claims Processing Manual — Pub. 100-04, Ch. 10, § 30.9 (PDF, 825.09 KB), "Claims for institutional inpatient services, that is inpatient hospital and skilled nursing facility services, will continue to have priority over claims for home health services under HH PPS."

Resolution

  • Palmetto GBA encourages you to use the date of the first Medicare billable visit in the episode as the date of service you submit with revenue code 027X or 0623 when billing non-routine or surgical dressing/wound care supplies. In many cases, this is the LIDOS that overlaps the inpatient stay.
  • If the inpatient facility has submitted their billing, you may be able to determine which date overlaps the inpatient stay by reviewing the DOEBA and DOLBA dates found on the beneficiary's eligibility file (ELGA page 01 or the eServices 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.
    • If you are unable to determine the overlapping date by looking at the beneficiary's eligibility file, please call the Provider Contact Center to receive this information
    • Access the rejected claim to determine which dates of service on your home health claim overlap the inpatient stay. This information is available on FISS Page 02. You may need to press the F6 key to scroll forward to view all of the FISS revenue pages.
    • Adjust the rejected claim using FISS Adjustment Option 33 to remove the incorrect date of service on FISS Page 02
      • Reminder: when claims reject, charges are placed into the NCOV CHARGES (non-covered charges) field on FISS Page 02. When using FISS for online adjustments, the revenue detail lines must be deleted and added back by re-entering the revenue code information in new detail lines.
      • For more information about adding and deleting revenue lines, access the DDE Module 5. Detailed instructions are also found here for using FISS to adjust a rejected claim.

Reminder: to select a rejected claim, you must change the "P" that defaults in the S/LOC field to an "R" and enter "B9997." You may also need to change the TOB to "32.”

  • Ensure that all of the required data elements for an adjustment are present prior to submitting it to Medicare. These include:
    • Type of bill (the third digit must be a "7")
    • Claim Change Reason Code
    • Document Control Number
    • Adjustment Reason Code (if submitting via FISS)
    • Remarks explaining the reason for the adjustment

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