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The Centers for Medicare & Medicaid Services (CMS) has reported the following two issues impacting all Medicare contractors:

Issue #1: Occurrence code 55, which was implemented with Change Request 7792, is required to be reported when the discharge status code reported on the claim is:

20 (expired)
40 (expired at home)
41 (expired in a medical facility)
42 (expired - place unknown)

However, 5010 claims submitted with the occurrence code 55 are being rejected before entering the Fiscal Intermediary Standard System (FISS). This problem affects all provider types.

Issue #2: Change Request 7755 requires hospice providers to report the certifying physician information (when different than the attending physician) in the referring physician 2310F loop on 5010 claims. However, these claims are being rejected before entering FISS. This problem is currently only affecting hospice providers.

CMS is working to resolve these issues as quickly as possible. Please be aware of these CMS processing issues.

If you have any questions, please contact Client Services at 1-888-348-8457, option 2.


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