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Last Modified: 10/13/2019 Location: FL, PR, USVI Business: Part A

Claims overlap FAQs

Q: Why is my claim overlapping another facility’s when my dates do not fall within their dates of service?
A: The facility with the claim for the earliest dates of service may have billed an incorrect patient discharge status code. Applying the correct patient status code will help assure that the facilities receive prompt and correct payment.
If your patient status code is incorrect, it can indicate a patient is still in your facility when, in fact, they were discharged and admitted to another facility. It is recommended that you submit an adjustment to update the patient status on your claim.
If the other facility has submitted an incorrect patient status code, it is recommended that you contact the other facility and ask them to update the patient status code on the claim.
Example: The claim indicates that the patient is still in the facility (patient status 30), but the patient was transferred to a Medicare certified Skilled Nursing Facility (patient status 03).
Refer to resolution tips for overlapping claims, the A/B Medicare administrator contractor (MAC) collaborative job aid on how to resolve and prevent overlapping claim situations.
Source: CMS internet-only-manual (IOM), publication 100-04, Chapter 25 external pdf file
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