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An overlap is when an incorrect claim is processed and posted to the Common Working File (CWF) resulting in claim overlap rejection(s) of subsequent claim(s) submitted by the same or a different provider. When more than one provider is involved, the providers must work together to resolve the error. Some overlapping claim examples include:

Yes, the Cost Outlier timetable example is designed to assist providers in determining if a claim qualifies as cost outlier. Prior to coding an inpatient cost outlier claim, first determine the diagnosis related group (DRG) cutoff date, by using the example timetable.

Definitions

View this article to see how the error rate is determined.

Reference the Outlier Flowchart after asking this question: Does the cost for an inpatient stay exceed the cost outlier threshold amount?

No. The services provided by physical therapist assistants (PTAs) cannot be billed incident to a physician/non-physician practitioner’s (NPP), because PTAs do not meet the qualifications of a therapist. Only the services of a licensed/registered physical therapist can be billed “incident to” a physician service. PTAs may not provide evaluation services, make clinical judgments or decisions, or take responsibility for the service. PTAs act at the direction and under the supervision of the treating physical therapist and in accordance with state laws.