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Hospice Overlap Dispute

On occasion, a hospice claim will receive an edit from the Common Working File (CWF) indicating your claim overlaps the dates of service on a claim from another Medicare provider (e.g., hospice, hospital, or skilled nursing facility providers).  This typically occurs in transfer situations, or when claims are submitted with incorrect dates of service, or a notice of election (NOE) is submitted before a prior hospice submitted their discharge claim. 

CGS encourages hospice providers who submit claims to CGS to work with the Medicare provider that is involved in the overlap situation.  However, if after three contacts, the hospice is not successful in resolving the overlap dispute, they may complete the "Hospice Dispute Request for AssistancePDF" form to request assistance from CGS.

Prior to submitting this form to CGS, review the important reminders below:

  • Ensure the information on the completed form is legible. Forms that are illegible will be returned.
  • Return completed forms via U.S. Mail or by fax, as indicated on the form.
  • The form must clearly document the attempts made to resolve the dispute with the other Medicare provider or it will not be accepted.
  • Documentation must include the notice of election statement, or the notice of transfer showing the date the beneficiary signed the statement.  Any other pertinent information should also be submitted. 

Please be aware that resolving hospice overlap disputes can be a lengthy process, especially when the other hospice has a Medicare Administrative Contractor (MAC) other than CGS.

Posted: 02.19.16

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