MM14227 - Long-Term Hospice Stay: New Edit to Prevent Overpayment
During a review of hospice claims, the MAC found billing anomalies on interim and final hospice claims with type of bills 813 or 814 and 823 or 824 for long-term hospice care exceeding 270 days. The MAC found that claims submitted with matching “admission” and “from” dates got past system edits. When this happens, the edits for long-term hospice care won’t activate because the calculation performed by the Fiscal Intermediary Shared System for these edits is based on the difference between the “admission” and “from” dates. To address this issue, we established an edit within the Common Working File (CWF).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 05, 2025
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