However, f the hospice can provide documentation showing an NOE is submitted on the day before a dark day period and the NOE does not receive a receipt date until the day following the dark days, the contractor shall grant an exception to the timely filing requirement. CMS expects these cases to be very rare.
EDI submissions require additional data not required by the NOE itself, to satisfy transaction standards. This data is described in a companion guide available on the CMS website at www. Hospices complete the following data elements when submitting an NOE. The post office box number or street name and number may be included. The State may be abbreviated using standard post office abbreviations. Five or 9-digit ZIP codes are acceptable. Use the information to reconcile provider number discrepancies.
A Through date is not required on NOEs. This item is used in conjunction with diagnoses and surgical procedures to identify inconsistencies. Admission Date The hospice enters the admission date, which must be the start date of the benefit period. When a new hospice admission occurs after a hospice revocation or discharge that resulted in termination of the hospice benefit, the new admission date cannot be the same as the revocation or discharge date of the previous benefit period.
The hospice date for coverage and billing is January 1, The first hospice benefit period ends 90 days from January 1, Condition Codes. Condition codes are not required on an original NOE. If the hospice is correcting an election date using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the NOE will be returned to the hospice.
Occurrence Codes and Dates The hospice reports occurrence code 27 and the date of certification. This date must match the From Date and Admission Date. Hospices may submit an NOE that corrects an election date previously submitted in error. In this case, the hospice reports the correct election date in the From Date, Admission Date and occurrence code 27 fields and reports the original, incorrect election date using occurrence code Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that election date with the corrected information.
Release of Information Valid values are: I- Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes Y -Yes, provider has a signed statement permitting release of information. For example, if Medicare is the primary payer, enter this information.
Attending Physician I. Other Physician I. The hospice enters the NPI and name of the hospice physician responsible for certifying that the patient is terminally ill, with a life expectancy of 6 months or less if the disease runs its normal course. When the attending physician is also the physician certifying the terminal illness, only the attending physician is required to be reported. A stamped signature is acceptable. An NOTR should not be used when a patient is transferred.
This process is to ensure that only the provider currently providing services to the beneficiary can submit the NOTR. Admission Date The hospice enters the admission date, which must be the start date of the benefit period in all cases except when a transfer occurs.
On a NOTR, the hospice enters the start date of the hospice benefit period in which the discharge or revocation is effective, not the initial hospice admission date. If the hospice is correcting a revocation date using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the NOTR will be returned to the hospice.
In this case, the hospice reports the correct revocation date in the Through Date field and reports the original, incorrect revocation date using occurrence code Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that revocation date with the corrected information. If a revocation date was submitted entirely in error for instance, the beneficiary actually transferred to another hospice, rather than revoking their hospice benefit , the hospice can remove the revocation date via Direct Data Entry by submitting TOB 8xB with zeroes in the Through date.
Release of Information. Valid values are: I - Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes Y - Yes, provider has a signed statement permitting release of information Provider Number The hospice enters their NPI. Medicare systems ensure that the provider number submitted on the NOTR is the currently active billing provider e. If any other provider number is submitted, the NOTR is returned.
For notice of elections effective prior to January 1, , the hospice enters the National Provider Identifier NPI and name of the physician currently responsible for certifying. The 8XC does not get submitted until after the other provider has finalized their billing. No through date is required.
In transfer situations, the receiving hospice should use their own admission date. Condition Codes Condition codes are not required on an original transfer notice. If the hospice is correcting a date of transfer using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the transfer notice will be returned to the hospice. Occurrence Codes and Dates An occurrence code 27 is not required on a transfer notice, unless the date of transfer is also the first day of the next benefit period.
Hospices may submit a transfer notice that corrects a date of transfer previously submitted in error. In this case, the hospice reports the correct effective date of the transfer in the From Date field and reports the original, incorrect effective date using.
Medicare systems use the original, incorrect date to find the benefit period to be corrected, then replaces that date of transfer with the corrected information. The entered dates will be voided since the beneficiary never participated with the hospice.
A cancellation notice removes the hospice election period that was created by an NOE. Cancellation notices are not needed to remove hospice benefit periods, which are automatically removed when all claims in the benefit period are cancelled. See section Cancellation notices can also be used to remove a transfer or a change of ownership that was submitted in error. Type of Bill. Any claims processed during the election must be cancelled before an election period can be removed.
When there has been a transfer or change of ownership, the From date on the 8xD must match the corresponding transfer or change date to ensure those dates are removed correctly.
Release of Information Valid values are: I-Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes,. Y-Yes, provider has a signed statement permitting release of information. A change of ownership typically occurs when a Medicare provider has been purchased or leased by another organization. Condition Codes Condition codes are not required on an original change of ownership notice.
If the hospice is correcting the effective date of a change using occurrence code 56, the hospice reports condition code D0. Occurrence Codes and Dates Hospices may submit a change of ownership notice that corrects the effective date of a change previously submitted in error.
In this case, the hospice reports the correct effective date of the change of ownership in the From Date field and reports the original, incorrect effective date using occurrence code Medicare systems use the original,.
Release of Information Valid values are: I-Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes, Y-Yes, provider has a signed statement permitting release of information.
This will avoid mistaking the change as a beneficiary-elected transfer. Hospice election and revocation date information are stored in a separate election period in Medicare systems from benefit period information, so the two types of information can be changed independently. When an 8xA is processed, the election date and receipt date will be updated on the election period CWF inquiry screen. The revocation date remains blank and the revocation indicator is 0. The NOE receipt date will be retained on the election period permanently.
If benefit periods are cancelled, this will not remove the NOE receipt date from Medicare systems. If the hospice files the discharge claim in lieu of the NOTR, the claim will also post the revocation date and revocation indicator on the election period, in addition to updating the Term Date1 of the benefit period to match the revocation date.
A later NOE for the same beneficiary when there is no revocation date on the election period will be rejected. Consistent submission of revocations, via NOTRs or claims, within 5 days of the revocation date as required by regulation, is very important to prevent this.
Benefit Periods The hospice benefit period file pre-existed the episode period file and retains all the same fields it had historically, but election-related fields on those screens will no longer be used.
Benefit period contain two columns of information. If the hospice is correcting an election date using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the NOE will be returned to the hospice.
Occurrence Codes and Dates The hospice reports occurrence code 27 and the date of certification. This date must match the From Date and Admission Date. Hospices may submit an NOE that corrects an election date previously submitted in error. In this case, the hospice reports the correct election date in the From Date, Admission Date and occurrence code 27 fields and reports the original, incorrect election date using occurrence code Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that election date with the corrected information.
Release of Information Valid values are: I- Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes Y -Yes, provider has a signed statement permitting release of information. For example, if Medicare is the primary payer, enter this information.
Attending Physician I. Other Physician I. The hospice enters the NPI and name of the hospice physician responsible for certifying that the patient is terminally ill, with a life expectancy of 6 months or less if the disease runs its normal course. When the attending physician is also the physician certifying the terminal illness, only the attending physician is required to be reported.
A stamped signature is acceptable. An NOTR should not be used when a patient is transferred. This process is to ensure that only the provider currently providing services to the beneficiary can submit the NOTR. Admission Date The hospice enters the admission date, which must be the start date of the benefit period in all cases except when a transfer occurs.
On a NOTR, the hospice enters the start date of the hospice benefit period in which the discharge or revocation is effective, not the initial hospice admission date. If the hospice is correcting a revocation date using occurrence code 56, the hospice reports condition code D0.
If the two codes are not reported together, the NOTR will be returned to the hospice. In this case, the hospice reports the correct revocation date in the Through Date field and reports the original, incorrect revocation date using occurrence code Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that revocation date with the corrected information.
If a revocation date was submitted entirely in error for instance, the beneficiary actually transferred to another hospice, rather than revoking their hospice benefit , the hospice can remove the revocation date via Direct Data Entry by submitting TOB 8xB with zeroes in the Through date.
Release of Information. Valid values are: I - Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes Y - Yes, provider has a signed statement permitting release of information Provider Number The hospice enters their NPI. Medicare systems ensure that the provider number submitted on the NOTR is the currently active billing provider e.
If any other provider number is submitted, the NOTR is returned. For notice of elections effective prior to January 1, , the hospice enters the National Provider Identifier NPI and name of the physician currently responsible for certifying.
The 8XC does not get submitted until after the other provider has finalized their billing. No through date is required. In transfer situations, the receiving hospice should use their own admission date. Condition Codes Condition codes are not required on an original transfer notice.
If the hospice is correcting a date of transfer using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the transfer notice will be returned to the hospice. Occurrence Codes and Dates An occurrence code 27 is not required on a transfer notice, unless the date of transfer is also the first day of the next benefit period.
Hospices may submit a transfer notice that corrects a date of transfer previously submitted in error. In this case, the hospice reports the correct effective date of the transfer in the From Date field and reports the original, incorrect effective date using. Medicare systems use the original, incorrect date to find the benefit period to be corrected, then replaces that date of transfer with the corrected information.
The entered dates will be voided since the beneficiary never participated with the hospice. A cancellation notice removes the hospice election period that was created by an NOE. Cancellation notices are not needed to remove hospice benefit periods, which are automatically removed when all claims in the benefit period are cancelled. See section Cancellation notices can also be used to remove a transfer or a change of ownership that was submitted in error.
Type of Bill. Any claims processed during the election must be cancelled before an election period can be removed. When there has been a transfer or change of ownership, the From date on the 8xD must match the corresponding transfer or change date to ensure those dates are removed correctly. Release of Information Valid values are: I-Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes,.
Y-Yes, provider has a signed statement permitting release of information. A change of ownership typically occurs when a Medicare provider has been purchased or leased by another organization. Condition Codes Condition codes are not required on an original change of ownership notice. If the hospice is correcting the effective date of a change using occurrence code 56, the hospice reports condition code D0. Occurrence Codes and Dates Hospices may submit a change of ownership notice that corrects the effective date of a change previously submitted in error.
In this case, the hospice reports the correct effective date of the change of ownership in the From Date field and reports the original, incorrect effective date using occurrence code Medicare systems use the original,. Release of Information Valid values are: I-Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes, Y-Yes, provider has a signed statement permitting release of information.
This will avoid mistaking the change as a beneficiary-elected transfer. Hospice election and revocation date information are stored in a separate election period in Medicare systems from benefit period information, so the two types of information can be changed independently. When an 8xA is processed, the election date and receipt date will be updated on the election period CWF inquiry screen. The revocation date remains blank and the revocation indicator is 0. The NOE receipt date will be retained on the election period permanently.
If benefit periods are cancelled, this will not remove the NOE receipt date from Medicare systems. If the hospice files the discharge claim in lieu of the NOTR, the claim will also post the revocation date and revocation indicator on the election period, in addition to updating the Term Date1 of the benefit period to match the revocation date.
A later NOE for the same beneficiary when there is no revocation date on the election period will be rejected. Consistent submission of revocations, via NOTRs or claims, within 5 days of the revocation date as required by regulation, is very important to prevent this.
Benefit Periods The hospice benefit period file pre-existed the episode period file and retains all the same fields it had historically, but election-related fields on those screens will no longer be used. Benefit period contain two columns of information.
One captures information on the original billing hospice and any hospice receiving a transfer. Benefit periods are created by submitting claims. If a hospice needs to cancel all the claims in a benefit period, Medicare systems will remove the hospice benefit period. The first claim submitted by the hospice after an election must ensure the From and Admission dates match the election period start date. This will ensure the first benefit period in the election is created correctly and subsequent claims will process.
Summary Chart The following chart provides a reference to help hospices understand which of their submissions will impact an election period or a benefit period. The rate paid for any particular day varies depending on the level of care furnished to the beneficiary.
A hospice day billed at the RHC level in the first 60 days of a. For each day that a Medicare beneficiary is under the care of a hospice, the hospice is reimbursed an amount applicable to the type and intensity of the services furnished to the beneficiary for that day. For continuous home care the amount of payment is determined based on the number of hours, reported in increments of 15 minutes, of continuous care furnished to the beneficiary on that day.
For the other categories a single rate is applicable for the category for each day. For the day of discharge from an inpatient unit, the appropriate home care rate is to be paid unless the patient dies as an inpatient. When the patient is discharged deceased, the inpatient rate general or respite is to be paid for the discharge date. A description of each level of care follows.
Routine Home Care - The hospice is paid the routine home care rate for each day the patient is under the care of the hospice and not receiving one of the other categories of hospice care. This rate is paid without regard to the volume or intensity of routine home care services provided on any given day, and is also paid when the patient is receiving outpatient hospital care for a condition unrelated to the terminal condition. Continuous home care is not paid during a hospital, skilled nursing facility or inpatient hospice facility stay.
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