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.
Specifically, Medicare will return to the hospice provider (RTP) claims (bill types 81x or 82x) with dates of service on or after July 1, 2013 when;
• There is a patient status code of 30 and the thru date of the claim does not equal the last day of the billing period month: or
• The claim from and thru dates span multiple months.
The 837Direct software application will help Hospice providers meet these new billing requirements with the creation of payer level edits to match the specifications in this change request. By adding these edits to 837Direct, this will prevent Hospice providers from creating and submitting claims that would otherwise be returned to the provider (RTP) via DDE.
For more information regarding 837Direct, click here.