Line Item Detail Billing and Automated Claim Adjustments

50.4 - Line Item Detail Billing and Automated Claim Adjustments (Rev. 1364, Issued: 11-02-07: Effective: 04-01-08; Implantation: 04-07-08) The implementation of line item detail billing for ESRD claims effective on April 1, 2007 requires that each service be submitted on a separate line with the appropriate line item date of service. The Medicare standard systems perform line item date of service compare for RDFs claims with statement billing periods overlapping the statement billing period of another processed claim. This prevents monthly claims from receiving overlapping edits based on the statement billing period dates but rather, only when the RDF claim has a line item that duplicates another processed claim or falls within the dates of an inpatient hospital stay. Standard systems reject only those overlapping line items while any line items not overlapping another claim continue to process for payment. As a result of this logic, the RDFs no longer have to submit the occurrence span code 74 on the monthly dialysis claim when an inpatient stay occurred during the same month. The initial line item detail billing instruction did not implement a process for rejecting services on the RDF claim overlapping an inpatient stay when the RDF claim is received before the inpatient hospital claim. A subsequent instruction implemented for April 1, 2008 requires the Medicare Common Working File (CWF) to create an informational unsolicited response prompting the standard system to perform an automated adjustment of the processed 72x claim that contains line item dates of service that are overlapping dates of an incoming inpatient hospital claim. The admission and discharge dates of an inpatient stay are not considered overlapping dates and may be payable to the RDF.