CMS Change Request (CR) 8142, will implement edits to return hospice claims to providers if they submit more than one claim per month per beneficiary or when they submit claims spanning more than one calendar month. These edits will affect claims with dates of service on or after July 1, 2013.
According to the “Medicare Claims Processing Manual”, Chapter 1, Section 50.2.2, hospices have repetitive billing requirements. The manual requires Hospice providers to perform calendar month billing. CR8142 enforces the calendar month billing requirement and creates standard system edits that will return claims to hospice providers when more than one claim per beneficiary is received in a single month. The exception to this processing requirement is if the beneficiary was discharged from the hospice or revoked the hospice election and later re-elected the benefit during the same month. Continue reading