Eli's Hospice Insider

Don’t let claims for your hospice patient’s entire stay get derailed just because the first claim wasn’t reimbursed.

So warns one HHH Medicare Administrative Contractor. “When all dates of service on a hospice claim are noncovered due to an untimely notice of election (NOE), the claim will reject with the reason code 39929 (claim rejected) and will finalize in the status/location R B9997,” explains MAC CGS in a recent post to its website. “Regardless of whether an exception is being requested, it is important to submit the next sequential hospice claim. Medicare regulations require that hospices bill on a monthly basis that conforms to a calendar month. Hospices must also submit claims in date sequence.”

How it works: “When a hospice claim is submitted, the Fiscal Intermediary Standard System (FISS) searches claim history for a prior claim,” CGS explains. “FISS does not search the RTP file (T B9997) for prior claims.”

FISS will search for prior hospice claims in any of these status/locations, however, CGS says:
S XXXXX (“S” means suspended); P XXXXX (“P” means processed/paid/partial denial); R XXXXX (“R” means rejected); and D XXXXX (“D” means denied).

Plus: “When a prior claim is found, but has not yet completed processing, FISS will hold the out of sequence claim until the prior claim has completed processing,” CGS adds.

More information is at www.cgsmedicare.com/hhh/pubs/news/2019/0119/cope10672.html.