July 10, 2025
Attention: Hospice Billing Reminders & a New Claim Edit
CGS has recently detected a significant number of incorrectly billed hospice claims. Please review the following details, billing reminders, and information.
Billing Error
Claims have been submitted for continuous care (TOB 8X3 or 8X4) using the admission date as the 'From' date of service on the claim, instead of the beneficiary's start of care date. The admission date must match the effective date of the hospice election or change of election. It cannot precede the physician’s certification by more than two calendar days. The admission date remains consistent on all subsequent claims for the same hospice election (CMS Medicare Claims Processing Manual (Pub. 100-04, Chapter 11, Section 30.3).
Billing Reminders
Claims must be submitted as follows:
- Frequency: Submit one claim per calendar month (e.g., June 1 – June 30).
Reference: CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 11, section 90
- Sequential order: Submit the prior month’s claim before the next month’s claim (e.g., June before July).
Reference: CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 1, section 50.2.3 – 50.2.4
- Admission (start of care) date: Report the hospice election or change of election effective date (e.g., The admission date stays the same on all continuing claims for the same hospice election.).
Reference: CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 11, section 30.3
- For claims submitted on or after July 3, 2025: Hospice claims will be returned to the provider (RTP) with reason code 70AD1, indicating that the admission date cannot be the same as the "From" date of service on an 8X3 or 8X4 type of bill. Please correct the claim.
For claims submitted prior to July 3, 2025: To ensure compliance with Medicare program requirements, we encourage you to submit claim adjustments for any billing or payment errors you identify.
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