New Edits Announced to Enforce Hospice Billing Requirements

Stay in Compliance With Your Monthly Billing Requirements.

Hospice Agencies need to prepare for new system edits that will go into effect in July. Change Request (CR) 8142 was released by CMS instructing contractors to implement system edits to return hospice claims to the provider when there is more than one hospice claim per month per hospice beneficiary or when the provider submits claims that span more than one calendar month.  The effective date of the edits is July 1, 2013, after which claims not in compliance with the monthly billing requirement will be returned to providers.

As the new hospice billing requirements unfold hospice providers should already be following the monthly billing requirements that are found in the Medicare Claims Processing Manual, Chapter 11, Section 90. There is no policy change included in the CR, it is simply announcing that enforcement will begin in July. If for any reason you have not already been following the monthly billing requirement or are not sure if you are, now is the time to review your current billing processes and verify they meet the necessary requirements.

To view the full change request click here.

As soon as CMS posts the corresponding MedLearn Matters HEALTHCAREfirst will post a link to it in our regulatory blog.