How to Resolve Claim Overlap Errors Documents to All LOB Ask-the-Contractor Teleconference (ACT)
View the handout for the December 2, 2020, How to Resolve Claim Overlap Errors Documents to All LOB Ask-the-Contractor Teleconference (ACT).
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- If a patient is discharged from the hospital to hospice on the same date with the same dx code, how do we get around the claim overlap?
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If there are no overlapping dates of service (other than admit/discharge), the claim should process.
Published: 12.23.20
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- What is the best way to resolve this problem when the other provider has a different MAC?
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answer
Published: 12.23.20
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- I've been told, "We're not cancelling our claim - take the PEP." How can I 'take the PEP' when my claim won't process at all?
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If another provider bills, your claim should process, as long as the dates don't overlap one another.
Published: 12.23.20
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- What do we need to watch out for to make sure a claim will not error for overlapping?
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It is important to perform the patient screening and ask the beneficiary questions upon admission. In addition, be sure to verify the beneficiary's eligibility.
Published: 12.23.20
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- If we do not receive notification of a transfer for a few days after the effective date and have visits—which date is honored?
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The notice of transfer should be sent within two days of receiving the beneficiary and the effective date on the notice of transfer is applied.
Published: 12.23.20
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- What do you do with the issues of patients transitioning from HH to PT in the community and our final DOS for nursing may eclipse their first DOS?
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If there are no overlapping dates of service (other than admit/discharge) the claim should process.
Published: 12.23.20
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- Member is on HH services, TIF to hospital mid-episode with anticipated return, HH final claim thru from overlap inpatient claim.
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Do not discharge unless the inpatient goes beyond the HH episode through date. Do not bill for dates of service on the line level for days the patient was in an inpatient setting.
Published: 12.23.20
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- How do you resolve a duplicate RAP sent? Our system somehow sent a duplicate RAP and I did not catch until it was posted to CWF
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If a duplicate RAP is submitted, the RAP should deny as a duplicate; therefore, no provider action would be required.
Published: 12.23.20
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- What is a provider to do when therapies such as physical and occupational deny for overlapping a home health episode?
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Under the PPS, a HHA must bill for all home health services which includes nursing and therapy services, routine and non-routine medical supplies, home health aide and medical social services, except durable medical equipment (DME). Refer to the CMS Pub. 100-04, Ch. 10, Section 20 for information about Consolidated Billing.
Published: 12.23.20
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- If there is an open hospice benefit period from 2016 and the last provider listed telephone is no longer working – can I just fill out a dispute form or still send a letter to that provider?
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If you've made every attempt to contact the provider to no avail, yes, you may submit the Hospice Dispute Request for Assistance Form
Published: 12.23.20
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- What is the web address for the overlapping claim form for J15 part A?
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Part A Dispute Request for Assistance Form
Published: 12.23.20
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- This is for HH: I have had a few situations that we submit and the RAP and FINAL pays then MCR comes back and adjusts because another HHA submits. Why should are claim be adjusted when we were paid and clearly had rights to the episode? I understand if the other agency adds the CC 47 but these should be looked into a little further. This causes us to send in payment disputes which 90% of the time CGS states they don't receive these so we have to send multiple disputes. It's so frustrating.
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We appreciate your concerns and know this can be frustrating. We've shared this information with our internal areas. The phase out of RAPs may eliminate this issue.
Published: 12.23.20
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- How do you resolve an overlapping claim with another home health agency if the last visits is 2 days after your start of care? The other provider did not show on an eligibility check at the time of service so there was no idea the patient had home health prior.
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Please make every possible effort to work with the other provider to resolve these types of issues. In the event you can't work together to resolve please refer to the Transfer Dispute Between HHAs page for additional instructions.
Published: 12.23.20
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- Is there a separate dispute form for Home Health?
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Notification of Disputed Home Health Agency (HHA) Transfer
Published: 12.23.20
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- Is there a separate dispute form for Hospice?
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Hospice Dispute Request for Assistance Form
Published: 12.23.20
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There was an additional question that was provider specific and not related to the How to Resolve Claim Overlap Errors Documents to All LOB. That provider was contacted after the event.