Frequently Asked Questions Overlapping Services/Claims
My home health claim overlaps an inpatient stay posted to the Common Working File (CWF). How can I resolve this?
HHAs should be aware that per the Medicare Claims Processing
Manual (Pub.
100-4, Ch. 10, 
§ 30.9), “Claims
for institutional inpatient services, that is inpatient hospital and
skilled nursing facility services, will continue to have priority over
claims for home health services under HH PPS.” To resolve
this billing error, please access the Web page, Top
Claim Submission Errors for Home Health Providers: Error C7080. Cahaba
encourages you to use the first Medicare billable visit in the episode
as the date of service submitted when billing non-routine supplies or
surgical dressing/wound care supplies to avoid errors for overlapping
inpatient stays as this is a common reason this billing error occurs.
(April - June 2008 FAQ – updated Nov. 2008)
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 9 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. This field corresponds with the “COND CODES” fields found on FISS claim page 01. For more information, please access Web page, Top Claim Submission Errors for Home Health Providers: Error C7010.
(April-June 2005 FAQ – updated Nov. 2008)
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 9 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 Home Health Providers: Error C7010.
(April-June 2005 FAQ – updated June 2008)
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 – reviewed Nov. 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 – reviewed Nov. 2008)
Page last updated: December 4, 2008
