CMS Targets Hospice Billing Anomalies

In an effort to combat billing anomalies on interim and final hospice claims that resulted in higher payment rates, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare Administrative Contractors (MACs) will begin to reject hospice claims that include the same date for both the "admission" and "from" fields in type of bills 813 or 814 and 823 or 824 for long-term hospice care exceeding 270 days. The changes will go into effect April 6, 2026.

MACs have found that claims submitted with matching "admission" and "from" dates got past system edits. When this happens, the edits for long-term hospice care will not activate because the calculation performed by the Fiscal Intermediary Shared System (FISS) for these edits is based on the difference between the "admission" and "from" dates.

The rejection codes associated with this change will include Claim Adjustment Reason Code 16 - Claim/service lacks information or has submission/billing errors; Remittance Advice Remark Code MA40 - Missing/incomplete/invalid admission date; and Group Code - CO (Contractual Obligation).