How Do I File Home Health and Hospice Claims to Medicare?

  • File via Electronic Claim Media (EMC): Most facilities submit claims electronically or employ a clearinghouse to submit claims electronically for them.
  • File via Direct Data Entry (DDE): Providers may manually use direct data entry (DDE) to submit their claims directly into the Fiscal Intermediary Shared System (FISS). However, the DDE program is usually used in tandem by facilities that electronically submit claims because of the functionality it offers. Providers are able to access various files, correct returned claims, see reports, check their financial claim summary and see the status and location of their processing claims. 
  • File using PC-ACE PRO32: CMS required Medicare Administrative Contractors (MACs) to offer free billing software to providers. Small providers may download the free PC-ACE PRO32 software to submit and manage their claims.
  • File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1450 paper claim forms. To see if you qualify for an exception, please reference page six of the The Medicare Learning Network (MLN) Booklet Medicare Billing Form CMS-1450 and the 837 Institutional.
Claims must be filed to the appropriate MAC no later than 12 months, one calendar year, from the date of service. Timely filing is determined by the date a processable claim is received by the appropriate MAC. Claims that are rejected as unprocessable are not considered submitted claims for the purposes of determining timely filing. Rejected claims must be corrected and resubmitted no later than 12 months from the date of service. Medicare will deny claims received after the deadline date. 

For more information on timely filing, including the limited exceptions to the 12-month timely filing period, see IOM Pub. 100-04, Chapter 1 (PDF, 1.62 MB), Section 70 - Time Limitations for Filing Part A and Part B Claims.

For information on submitting a request for a timely filing extension, see Checklist for Timely Filing Extension.

Claims Articles

32162Reason Code 34952Reason Codes 38031, 38157, 38158 and 38200Reason Code 30949Reason Code 31566Reason Code 13599Reason Code 15701Reason Code 32403Reason Code N5052Reason Code 12102Reason Code 37541Reason Code 32032Reason Code U5211Reason Code 32402Reason Code U5391Reason Code 38107Reason Code 3142816501Reason Code 32030Reason Codes 39071, 39072, 39073Reason Code U5150Reason Code 32243Reason Code 31503Reason Code 32404Reason Code 32907Reason Code 1461A32968Reason Code U5106Reason Code 37257Reason Code 37238Reason Code 31485Reason Code 38050Reason Code U538IReason Code 31313Reason Code 31287Reason Code U538FReason Code U5157Reason Code 32710Reason Code U5111Reason Code 37402Reason Code 5Z72FReason Code 32445Reason Code 31755Reason Code 31102Reason Code U5194Reason Code 37253Reason Code 31689195041920130908Reason Code 11501Reason Code 3160530914Reason Code 38055Reason Code 3141834927Reason Code 37236Reason Code U5181Reason Code 34923Reason Code 31282Reason Code U5200Reason Code W7A01RESOLVED: Home Health Accountable Care Organization (ACO) Reductions Not Recouping Request for Anticipated Payment (RAP) Reimbursement with Reason Code 3719QHospice Payment Rates for Routine Home Care (RHC) on and after January 1, 2016Hospice Notice of Transfer (NOTR), Type of Bill (8XC)RESOLVED: Claims Returning for Reason Code C5467 for the Review Choice Demonstration (RCD)RESOLVED: Home Health: Reason Code 38107: Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not MatchRESOLVED: Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not MatchRESOLVED: Home Health Reason Code C727E - Home Health PDGM Claims are Suspending Incorrectly with Reason Code C727ERESOLVED: Home Health Reason Code 37253 - Claims Returned to Provider (RTP) Due to OASIS Assessment Not FoundHospice Claims Editing for Reason Code U5181RESOLVED: Home Health: Penalty for Requests for Anticipated Payments (RAPs) Received More Than Five Days EarlyRESOLVED: No Payment Amount on Low Utilization Payment Adjustment (LUPA) Claims with Late Requests for Anticipated Payment (RAP) PenaltiesHospice Period Dates Not Calculating Correctly on the Common Working File (CWF)Recoding of Health Insurance Prospective Payment System (HIPPS) Codes from Late to Earlier Periods on Home Health Claims When There Is Separation Between the Periods of Less than 60 DaysRESOLVED: Home Health HIPPS Recoding Error Affecting Claims that Span January 1, 2020Reason Code 31276Reason Code 39929Reason Code 32105Reason Code 39011Reason Code 32400Reason Code 30928Reason Code U6805Reason Code 31947Reason Code C7010Reason Code C7080Reason Code U6825Reason Code U5233Reason Code 56900Home Health: Penalties for Late Requests for Anticipated Payments (RAPs) Not Being Deducted from Final ReimbursementHome Health: Medicare System Not Recoding the Health Insurance Prospective Payment System (HIPPS) Code on Some ClaimsChecklist for Timely Filing ExtensionNew Medicare Beneficiary Identifier (MBI) Get It, Use ItMedicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) Lookup ToolMedicare Beneficiary Identifier (MBI) ReminderHome Health Reason Codes U524P/U524Q - Some Home Health Final Claims are Cycling in the System for the Timing of the Period/EpisodeApril 2021 Release Dark Days for the Common Working File (CWF) HostsHome Health: Payment on Claims When the Requests for Anticipated Payment (RAP) Were Submitted More than 30 Days LateRESOLVED: Hospice Reason Code U5106: Notices of Elections (NOEs) Posting Elections to the Common Working File, But Returning to ProviderRESOLVED: Home Health Reason Code W7216 - Requests for Anticipated Payments (RAPs) Returned to Provider (RTP) Incorrectly for an Invalid Line Item DateRESOLVED: Home Health: 2020 Requests for Anticipated Payments (RAPs) UnderpayingRESOLVED: Home Health: Claims Spanning 2020-2021 Not Applying Correct 2021 Payment RateRESOLVED: Home Health: Low Comorbidity Adjustment for Claims with COVID-19 Diagnosis Code U07.1Why did my patient's MBI change and which MBI do we use?Sequestration Reduction Applied Incorrectly on April 2021 Dates of ServiceHome Health: Reason Code 37363 Editing on Low Utilization Payment Adjustment (LUPA) ClaimsHome Health: Reason Code 37257, Missing or Invalid Federal Information Processing Standards (FIPS) County CodeRESOLVED: Home Health: 2021 Payment Adjustment for the Home Health Value Based Purchasing (HHVBP) ModelRESOLVED: Home Health: PCR Duplicate Request Rejections