New Edits on Hospice Claims

Recently, CMS released Change Request (CR) 8142Hospice Monthly Billing Requirement, effective date of change- July 1, 2013. The CR instructs Medicare contractors to implement a system edit to return hospice claims to the provider when there is more than one hospice claim per month per beneficiary. The only exception to this requirement is in the case of the beneficiary being discharged or revoking the benefit and then later re-electing the benefit during the same month.

Medicare contractors will also implement a system edit when the provider submits claims that span more than one calendar month.  Any hospice claim spanning multiple months will be returned to the provider for correction.

This is not new policy but is a new enforcement.  After July 1, 2013 claims not in compliance with the monthly billing requirement will be returned to providers.  A corresponding MedLearn Matters article is expected to be posted in the near future.

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