Overlap Billing for All Ask-the-Contractor Teleconference (ACT)
View the handout for the September 22, 2021, Overlap Billing for All Ask-the-Contractor Teleconference (ACT).
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- How do we avoid Home Health Raps going to RTP due to Hospice not filing their revocation?
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Check beneficiary eligibility (IVR, DDE, myCGS, HETS). If the hospice revocation indicator is 0 (zero) (i.e., open), contact the hospice facility to close the record.
Published: 10.07.21
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- If we have attempted to contact an overlapping provider and there is no resolution, are providers to submit a transfer dispute?
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Yes, you may complete the appropriate dispute form to request CGS' assistance.
Published: 10.07.21
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- How do handle overlap rejections due to future RAPs where the other provider discharged but did not cancel their RAP? How are providers supposed to abide by the 5-day rule for overlapping when other providers who have billed future RAPs do not cancel?
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The RAP for the second 30-day billing period would not need to be cancelled because the RAP-only record remaining on Common Working File (CWF) will not trigger consolidated billing edits. However, cancelling an unused RAP will help maintain a more accurate beneficiary home health eligibility record. Maintaining an accurate eligibility record may reduce calls due to the posted 30-day period from other HHAs seeking to coordinate transfers or providers of services included in home health consolidated billing regarding services under arrangement. Assisting the providers may require cancelling the RAP at a later date, if necessary. Please contact the PCC so they can review the specific patient situation and advise.
Published: 10.07.21
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- If a patient elects hospice on the same date but after discharge from a hospital outpatient service, who should be billed Medicare or Hospice? How do you appropriately bill palliative care services provided on the same day, but prior to election of hospice benefit?
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Medicare. If there are no overlapping dates of service (other than admit/discharge), the claim should process.
Published: 10.07.21
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- What happens if you see a patient a few hours before they elect their hospice benefit? Who is responsible for the bill its related?
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The provider that rendered the services prior to the hospice election is responsible for submitting the claim. If the admit/discharge date is the only overlapping date of service, you should not receive an overlap edit.
Published: 10.07.21
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- If we receive an error with reason Code stating there is an overlap with Home Health and we verify who the home Health provider is, are we able to submit with any information on an adjusted claim to pay the services not part of the Home Health?
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Services not included in home health consolidated billing will not receive an overlap edit. You may need to verify the dates of service, discharge status, services reported and correct your claim. If you feel your claim was submitted correctly, you may need to contact the home health agency to verify the information submitted on their claim.
Published: 10.07.21
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- What should providers do when a Home Health claim overlaps another HHA but the other agency refuses to pull back their claim from the CWF?
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You may complete the form below, including your attempts to contact the overlapping HHA, to request CGS' assistance.
Published: 10.07.21
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- What are hospice providers to use when getting the overlap error due to a hospital's billing? The hospital refers the patient to hospice. The patient is admitted to hospice same day of hospital discharge. The hospice claim then goes into RTP for overlap.
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An overlap edit should not apply if the admit/discharge date is the only overlapping date of service on the claims. You may need to contact the hospital to verify the dates of service and/or discharge status reported on their claim.
Published: 10.07.21
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- Regarding overlaps with Medicare Advantage plans, what if the information is verified at time of service, but MA plan denies claim due to patient having Medicare from SOC?
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If the patient is enrolled in a MA plan on the date of admission, submit your claim to the MA plan. If the patient enrolls in a MA plan after the date of admission, submit your claim to Medicare.
Published: 10.07.21
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- On claims when the patient has an MA plan and elects hospice AFTER discharge from outpatient hospital services, who should be billed the MA Plan, Medicare, or Hospice?
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Medicare Fee for Service retains payment responsibility for all hospice and non-hospice related claims beginning on the date of the hospice election.
Published: 10.07.21
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