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Impact of an Inpatient Admission While Receiving Home Health Services

Claims for dates of service when a beneficiary was receiving services in an inpatient hospital or skilled nursing facility have priority over claims for home health services under HH PPS. If a home health claim is received and a line item date of service billed falls within the dates of an inpatient or SNF claim (not including the dates of admission or discharge), the claim will reject with reason code C7080. See the Medicare Claims Processing Manual (Pub. 100-04, Ch.10, § 30.9External PDF) for more information on the coordination of HH PPS claims with inpatient claim types.

If a beneficiary receiving home health care enters the hospital for a short stay during the 60-day/30-day period of care episode, the home health agency may choose to discharge the beneficiary based on the expectation that the beneficiary will not return to them in the same 60-day/30-day period of care episode. In this situation, the agency should understand that the discharge is not recognized for Medicare payment purposes, and therefore, the same episode continues. If the beneficiary does return to the same HHA after they are discharged from an inpatient facility, the HHA will need to bill one claim for all of the home health-related services occurring both prior to and after the inpatient admission that are provided in the entire 60-day/30-day period of care period. Additional information on this topic is available in the Medicare Claims Processing Manual (Pub. 100-04, Ch.10, § 10.1.14External PDF)

If the beneficiary does not return to the HHA at the end of the 60-day certification period, the HHA should discharge the beneficiary.  If the beneficiary returns to the HHA after an inpatient stay that spans the end of the 60-day certification period, a new start of care assessment and a RAP and claim with a new admission date are required.

Inpatient Stays Spanning the End of a 30-day Period (services after January 1, 2020)

For services after January 1, 2020, discharge is not required if the beneficiary has an inpatient stay that spans the end of the first 30-day period of care in a certification period.  Submit the RAP and claim for the period following the discharge as if the 30-day periods were contiguous – submit a FROM date of day 31, even though it falls during the inpatient stay and the first visit that occurs after the hospital discharge.  Medicare systems will allow the claim to overlap the inpatient claim for dates in which there are no visits made.

Refer to the Medicare Claims Processing Manual (Pub. 100-04, Ch.10, §80.BExternal PDF) for information about "Inpatient Hospital Stays On or Near Day 60/61 of Continuous Care Episodes".

Additional CMS Resources

Updated: 12.23.19

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