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Billing Overlap/Dispute Resolution Process Effective 3/1/2023

An overlapping situation may occur between hospitals for inpatient stays, home health agencies, outpatient services and hospice agencies. Overlapping situations may also occur due to SNF or home health consolidated billing, or the POS submitted on physician claims where the SNF or home health has failed to properly discharge the beneficiary.

In situations where resolution cannot be met, please submit an RFA Form to National Government Services for assistance.

Required documentation to include with RFA Form:

  • Records of admission and discharge of patient stay
  • Signed Patient Transfer Form (If overlap exist)
  • Point of Contact made to overlapping facility made (must have at least three contacts made, must include an internal communication log with records)
  • Email, phone, fax or mail acceptable (One of the three attempts must be written communication. Documentation of email or mail must be included in records)

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Revised 4/11/2024