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National
Government Services, Inc.
Medicare Monthly Review Part A and B |
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A
Combined Part A and Part B Newsletter |
MLN Matters. . .Information
for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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MMR-2007 12A, December 2007
MLN Matters Number: MM5768
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Related Change Request (CR)
#: MM5768 |
Related CR Release Date: November
2, 2007 |
Effective Date: April 1, 2008 |
Related CR Transmittal #: R1364CP |
Implementation Date: April
7, 2008 |
Medicare’s Common Working File (CWF) Informational Unsolicited Responses for RDF Claims Overlapping Inpatient Hospital Stays
Provider Types Affected
Renal Dialysis Facilities (RDF) submitting claims to Medicare
contractors (fiscal intermediaries (FI) and/or Part A/B Medicare
Administrative Contractors (A/B MAC)) for services provided to
Medicare beneficiaries
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5768, which changes
processes for Common Working File (CWF) Informational Unsolicited
Responses for RDF Claims Overlapping Inpatient Hospital Stays.
What You Need to Know
CR 5768 implements an informational unsolicited response from
the CWF to prompt the Medicare systems to adjust 72X claims that
have line item dates of service overlapping a subsequently received
inpatient claim.
What You Need to Do
See the Background and Additional Information sections of this
article for further details regarding these changes.
Background
CR 5039 implemented line item billing for RDFs effective April
1, 2007. (See related MLN Matters article, MM5039 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5039.pdf
on the CMS Web site.) In addition, CR 5039 (Transmittal 1084)
implemented system functionality in the Medicare systems to compare
line item dates of service on RDFs claims to the dates of services
on other potential overlapping claims. When an incoming RDF claim
(bill type 72X) includes line item dates of service(s) that are
included in an inpatient claim, the line item services that are
listed with dates that overlap the inpatient stay dates are rejected
while allowing the remainder of the claim for dates of service
that are not overlapping to be paid. RDFs may bill for and be
paid for services on the admission date and discharge date of
a hospital stay. Therefore, the inpatient admission date and discharge
date are not considered overlapping dates of service. CR 5039
(Transmittal 1084) did not include a process for rejecting services
on the RDF claim overlapping an inpatient stay when the RDF claim
is received before the inpatient hospital claim.
Therefore, CR 5768 implements processes in Medicare systems to
identify previously processed RDF claims received for a patient
where a subsequent inpatient claim is received. When such RDF
claims are identified, Medicare systems will adjust the already
processed 72X claims that have line item dates of service overlapping
the incoming inpatient claim.
Additional Information
The official instruction, CR5768, issued to FI and A/B MAC regarding
this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1364CP.pdf
on the CMS Web site. The revised sections of Chapter 8 of the
Medicare Claims Processing Manual are attached to CR5768.
If you have any questions, please contact your FI or A/B MAC
at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip
on the CMS Web site.
Disclaimer
This article was prepared as a service to the public
and is not intended to grant rights or impose obligations. This
article may contain references or links to statutes, regulations,
or other policy materials. The information provided is only intended
to be a general summary. It is not intended to take the place
of either the written law or regulations. We encourage readers
to review the specific statutes, regulations and other interpretive
materials for a full and accurate statement of their contents.
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