CMS: Hospice Claim Rejections Due to Admission and Election Date Edit

A Centers for Medicare and Medicaid Services (CMS) change request prevents overpayments of long-term hospice care that took effect April 1, 2026.

Unfortunately, the edit is now impacting hospice institutional claims. Medicare Administrative Contractors, Wellpoint Federal, CGS, and Palmetto, sent notices to providers that claims are failing system edits when the transfer date is populated as the admission date.

The claims return with edits U5565 and U5566, preventing successful claim creation/submission. The MACs are overriding the edit and allowing the impacted claims to process. Hospices that have had an initial claim return for reason codes 37402, U5565 and U5566 after a hospice-to-hospice transfer that occurred on or after April 1, 2026, may resubmit the claim using the transfer date as the admission date. MACs anticipate a fix will be implemented in the January 2027 release.