This article was originally published by the American Health Lawyers Association. Copyright 2014, American Health Lawyers Association, Washington, DC.  Reprint permission granted.

On February 5, CMS issued Change Request 8569 instructing Medicare administrative contractors (MACs) to implement system edits to prevent payment of respite care for more than five days at a time for any hospice claim submitted on or after July 1. Under current regulations, respite care under the Medicare hospice benefit is payable only for periods of up to five consecutive days. Days of respite care beyond five days must be billed at the appropriate home care rate for payment consideration. When there is more than one respite period in the billing period, the individual respite periods cannot exceed five days–including consecutive respite periods. Medicare systems currently do not provide standard editing to enforce this payment rule. To prevent potential overpayments in the hospice benefit, the new edits will be implemented to enforce the regulatory requirement. On or after July 1, claims reporting respite periods greater than five consecutive days will be returned to the provider.

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