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November 10, 2020

Hospice End of Life (EOL) Service Intensity Add-on (SIA) Payment

CGS has been notified that an issue causing EOL SIA overpayments has been resolved with a fix that was implemented on October 19, 2020.  This issue affected few hospice providers and occurred when the hospice claim was originally submitted incorrectly with a patient status of 40, 41 or 42, and the EOL SIA payment was applied.  When an adjustment was made to change the patient status code to one other than 40, 41 or 42, the EOL SIA payment was still made.

Claims that have been adjusted between January 1, 2016 and prior to January 1, 2020, to change the 40, 41, or 42 patient status code, and the EOL SIA payment was still made incorrectly, can now be adjusted to receive the correct payment.  It is important that you report the Claim Change Reason Code (Condition Code) EO “change patient status” when submitting your adjustment.

If your adjustment is untimely, you will need to follow the Reopenings process by submitting a hardcopy UB-04 adjustment (type of bill XX7), or a reopening request (type of bill XXQ). Be sure to make a note referencing “FS1244 – EOL SIA correction”.  This will allow the claims department to bypass the timeliness edits and allow the adjustment to process.


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