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Q&A: Overlapping claims

Patient Financial Services Weekly Advisor, March 14, 2008

Q: When do overlapping claims occur?

A: Overlapping claims (multiple claims with the same or similar dates of service or billing period) occur when a date of service or billing period conflicts with another, indicating that one or other may be incorrect. Sometimes this happens when the provider is seeking to avoid having a claim be rejected; for example:

• When some End Stage Renal Disease (ESRD) facilities prefer to obtain the inpatient hospital benefit days for the month, prior to the ESRD monthly bill being generated, thus allowing the facility to code the claim appropriately and bill around the inpatient hospital stay/stays; or
• Skilled nursing facility and inpatient hospitals stays. These situations fall into the category of disclosing information needed to bill Medicare properly, and information can be released as long as all authentication elements are met.

Source: Centers for Medicare and Medicaid Services

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