Last Modified: 6/27/2020
Location: FL, PR, USVI
Business: Part A
Q: My inpatient claim is overlapping a home health episode with the same date(s) of service. How can I resolve this?
A: Claims for inpatient hospital and skilled nursing facility (SNF) services have priority over claims for home health services, because beneficiaries cannot receive home care while they are institutionalized. A beneficiary cannot be institutionalized and simultaneously receive home care.
• Verify dates of service on your claim
• If dates of service are incorrect, correct your claim and resubmit.
• If dates of service are correct, it is recommended that you contact the home health agency and ask them to correct their claim.
• Edit exclusions:
• The inpatient claim admission date is the same as the home health agency transfer/discharge date
• The inpatient claim discharge date is the same as the home health agency admission date
• The inpatient claim dates are between the occurrence span code 74 ‘From’ date and the day following the occurrence span code ‘Through’ date
Source: CMS internet-only-manual (IOM), publication 100-04, Chapter 10
, section 30.9
publication 100-04, Chapter 25
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