To: NHPCO Members
From: NHPCO Health Policy Team
Date: October 05, 2012

Claims Processing Issues Identified for Hospice Providers

NHPCO has learned that there are two claims processing issues for hospice providers that are impacting claims processing for Medicare hospice claims submitted on or after October 1, 2012.  The issues are impacting all Medicare Administrative Contractors (MACs).  The Centers for Medicare and Medicaid Services (CMS) is aware of the issues and is working to resolve them as quickly as possible.

The claims processing issues are as follows:

Issue #1:  Occurrence code 55, which was implemented with Change Request 7792, is required to be reported when the discharge status code reported on the claim is a 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown).  However, claims submitted with the occurrence code 55 via the 5010 format are being rejected before entering the Fiscal Intermediary Standard System (FISS).  This problem affects all provider types, and is being researched.  Until the issue is resolved, providers may choose to submit these claims to CGS via Direct Data Entry (DDE).

CMS Update:  Claims submitted on 10/1 and 10/2 were not being accepted.  That problem was corrected on 10/2, so any claims filed after 10/2 should clear the system with no problems. Providers can resubmit.

Issue #2:  Change Request 7755 requires hospice providers to report the certifying physician information (when different than the attending physician) on the claim in the referring physician 2310F loop of the 5010 format.  However, claims reporting physician information in the 2310F loop are being rejected before entering FISS. This problem is currently only affecting hospice providers, and is being researched.

CMS Update:  No new information on when this issue will be fixed.  CMS will notify NHPCO and the MACs when the issue is fixed.

Until the issues are resolved, providers should submit claims to their MAC via Direct Data Entry (DDE).

Monitor your MAC’s list serve to check for the status of this issue.