(SCENARIOS)

- 1. ER and OR billed on separate dates w/ ancillary services.  Solution: Pass the SF w/ ER as one case rate, w/another case rate. Rule/PM 42-12, all services should be included in ER regardless of DOS 

- 2. ER and OR have overlapping DOS. Solution: Pass the SF w/ ER as one case and the highest billed charge and pass the OR w/ a separate case rate.  Any additional OR should be passed as 42-26 as part of the OR case rate. Roll up the ancillary service as part of ER case. 

- 3. Multiple ER services billed on the same DOS. Solution: Pass the SF w/ highest charge as the case rate: Any additional ER services should be indicated in the case rate. 

- 4. Multiple OR billed on separate DOS. Solution: Pass the SF with only one case rate. 

- 5. Multiple OR billed w/ ancillary services. Solution: roll ancillary services into the OR case rate. 

