- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Reason Code 39929
- Influenza and Pneumonia Vaccinations in the Home Health and/or Hospice Setting
- Certification or Recertification of Medicare Covered Home Health Services
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- MLN MattersĀ® 11855 Request for Anticipated Payment Submission Frequently Asked Questions
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Counting 60-Day Episodes
- Notice of Admission Questions and Answers
- Home Health Patient-Driven Groupings Model (PDGM) FAQs
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Requests for Anticipated Payment
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Episodes with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- Correcting and Avoiding Overlap Reason Codes
- 30-Day Home Health Therapy Reassessment Schedule
Correcting and Avoiding Reason Code C7080: Inpatient Overlap
This edit is applied to a home health episode claim that overlaps an inpatient claim in the system. A home health agency may bill for a visit on the day of inpatient admission and/or the day of inpatient discharge; however, there can be no dates of service that overlap the inpatient stay dates.
Provider Action Steps
Verify that the line item dates of service billed on the home health episode claim do not fall within the from and through dates of an inpatient hospital or skilled nursing facility claim. Providers may call the IVR or the Provider Contact Center for exact inpatient dates of service.Providers may also check the Health Insurance Query for Part A (HIQA) for Part A inpatient benefit periods:
Please note: The DOEBA and DOLBA dates represent the date span of the Part A benefit period and may not be actual claim dates (From and Through dates). The HIQA is a good resource to find out if Part A benefits have been utilized. The home health agency may also wish to verify with the inpatient facility that the correct dates were billed on the inpatient claim.
How to Avoid This Reason Code
- Double check the dates of service keyed on the episode claim prior to billing.
- Check the CWF for the utilization of Part A inpatient benefits.
- Develop an internal process or checklist of systems/information that must be confirmed before submitting claims to Medicare.