Frequently Asked Questions Overlapping Services/Claims
My claim rejected and the reason code states that I'm overlapping a hospice election period. How can I tell if a beneficiary has elected the Medicare hospice benefit?
If a patient has elected the Medicare hospice benefit, this information will be posted to their eligibility file. Providers can determine this by viewing page 2 of ELGA, and page 6 of ELGH. For more information on how to read these screens, please access the Checking Beneficiary Eligibility section of the FISS Reference Guide,.
While a patient has elected the hospice benefit, the hospice agency is responsible for providing all care related to the terminal diagnosis. Medicare will not reimburse services submitted by other providers that are related to the terminal diagnosis while the patient has elected hospice. Medicare will reimburse services that are unrelated to the terminal diagnosis. Providers must indicate the services as unrelated by using a condition code 07 in FL 18-28 on the UB-04 claim form. For more information, please access Web page, Top Claim Submission Errors for All Providers (Except Hospice): Error C7010.
(April-June 2005 FAQ – updated Dec. 2007)
My RAP/home health claim needs correction and the reason code states that the episode overlaps an existing episode with the same or different provider number. How can I tell if a beneficiary is in a current home health episode?
ELGA and ELGH, the patient eligibility screens, can provide information on billing periods established by other provider types. Using information found in these screens can assist you in resolving claim errors that occur due to overlapping dates of service with another provider.
Page 3 of ELGH and page 4 of ELGA will help you determine if the patient is in a current home health episode. If your dates of service overlap an existing episode, you may need to call the other agency. The provider number of the agency can be accessed from the PROV NUM field on page 3 of ELGH.
Once you have reviewed ELGH page 3, access the Cahaba quick reference tool, Avoiding Billing Errors Caused By Overlapping Home Health Episodes to determine the action that should be taken. If you are unable to resolve the overlapping issue after reviewing ELGH and using the quick reference tool, call the Cahaba Provider Contact Center at (877) 299-4500.
(April-June 2005 FAQ – updated March 2008)
We admitted a patient who is in a current home health episode. I need to know how to contact the other home health agency to figure out if they discharged the patient.
The names, provider numbers, and addresses of home health agencies are available on the Centers for Medicare & Medicaid Services (CMS) Web site. It can be accessed from the Cost Report 
page. To access home health information, click on Home Health Agency and scroll down to the list of downloads. Select “HHA Provider ID Information”. If you are unable to determine the contact information using this resource, call the Cahaba Provider Contact Center at (877) 299-4500.
(April-June 2005 FAQ – updated Sept. 2007)
Page last updated: May 8, 2008
