Effective July 1 2022, a claims processing edit to prevent gap billing between hospice transfers will be implemented. Per Change Request (CR) 12619 Gap Billing Between Hospice Transfers, a patient can change hospices only once per benefit period (60-day or 90-day). When the patient transfers to a different hospice, he or she continues in the same benefit period. To transfer hospice programs, the individual or representative must file, with the hospice from which care has been given and with the newly designated hospice, a statement that includes the following information:
- The name of the hospice from which the individual was given care and the name of the hospice from which he or she plans to get care.
- The date the change is to be effective.
Given that hospices bill for the date of discharge or transfer, for claims purposes, the “from date” for the receiving hospice must be the same as the “through date” for the transferring hospice, otherwise this would be a gap in care and a gap in billing and wouldn’t be considered a transfer. For example, if a patient chooses that a transfer is to be effective on January 10, the transferring hospice’s “through date” must be January 10 and the receiving hospice’s “from date” must be January 10 in order to be a continuous hospice election without a gap in care or billing. The transferring hospice is responsible for the patient up until, and including the transfer date.
If the patient is transferring from outside the service area and the transferring hospice can’t arrange care until the patient reaches the new hospice, the hospice may discharge the patient. This way, if the patient requires medical treatment while in the process of transferring, he or she can access it under his or her Original Medicare coverage. This would end the patient’s current benefit period and require the patient to re-elect hospice coverage at the new hospice and begin a new benefit period.
The hospice transfer will be rejected if the transfer doesn’t occur immediately. If the receiving hospice’s claim “from date” isn’t the same as the “through date” with “patient status” indicating a transfer (codes 50 or 51), the transfer will be rejected.
Transfers aren’t allowed from the same provider. Hospices must not send an 8XC if the CMS Certification Number (CCN) is the same. In this case, the patient isn’t transferred to another hospice, they’re transferred to another location of the same hospice.
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
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