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.