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Last Modified: 6/14/2022 Location: FL, PR, USVI Business: Part A

Claims overlap FAQ -- Home health episode overlap

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 (DOS) on your claim
If DOS are incorrect, correct your claim and resubmit.
If DOS are correct, it is recommended 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
Refer to resolution tips for overlapping claims, which is the A/B and home health and hospice (HHH) MAC collaborative job aid on how to resolve and prevent overlapping claim situations.
Source: CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 10, section 30.9 external pdf file and Chapter 25 external pdf file
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