Hospice Billing When a Notice of Election (NOE) was Filed Untimely Job Aid
In accordance with Change Request 8877, effective October 1, 2014, timely-filed hospice Notice of Elections (NOEs) shall be filed within five calendar days after the hospice admission date. A timely-filed NOE is a NOE that is submitted to the Medicare contractor and accepted by the Medicare contractor within five (5) calendar days after the hospice admission date. This means that the NOE was not returned (RTP’d).
In instances where a NOE is not timely-filed, the Medicare contractor shall not cover and pay for the days of hospice care from the hospice admission date to the date the NOE is submitted to, and accepted by, the Medicare contractor. These days shall be a provider liability, and the provider shall not bill the beneficiary for them.
When the hospice did not file the NOE timely, it may request an exception on the claim (do not request an exception on a NOE). Examples of valid qualifying exceptions are as follows:
- Fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate
- An event that produces a data filing problem due to a Centers for Medicare & Medicaid Services (CMS) or Medicare contractor systems issue that is beyond the control of the hospice. Example: sequential billing requirements that require a second hospice to remove its timely filing NOE and claims so a previous provider can bill
- A newly Medicare-certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its’ user ID from its’ Medicare contractor or
- Other circumstances determined by the Medicare contractor or the CMS to be beyond the control of the hospice. This exception will be evaluated on a case by case basis. This includes inadvertent errors as discussed in SE1633 that cannot be immediately corrected due to Medicare system constraints in which the hospice took appropriate actions within two business days to make corrections. Please see the 'Notice of Election (NOE) Timely Filing and Exceptional Circumstance Guidelines' job aid for help with submitting NOEs and error resolution.
When requesting an exception, the hospice shall include the following information on the claim, in addition to all other required claim information:
|
DDE Field |
Description/Valid Values
|
|---|---|
|
OSC |
Enter Occurrence Span Code (OSC) 77 to identify the provider liable non-covered days. The date span should include all days from the admission date until one day prior to the NOE receipt date. |
|
REV CD |
Enter the appropriate level of care and any appropriate discipline revenue code(s) for the dates not covered. Enter a separate line item with the appropriate revenue code(s) for the covered days. |
|
HCPC |
Enter appropriate HCPCS 'Q' code for each level of care line or HCPCS 'G' code for each discipline. |
|
MODIFS |
Enter the KX HCPCS modifier on HCPCS 'Q' code for each level of care line item. |
|
TOT UNT |
For all level of care revenue codes except 0652, the number of units should be the number of consecutive days at that level of care. Units for discipline revenue codes and 0652 should be entered as 15-minute increments (ex: 30 minutes = 2 units). |
|
TOT Charge |
Enter the total charge for each revenue line item. |
|
NCOV CHARGE |
Enter non-covered charges for each line item. |
|
REMARKS |
Enter the reason for exception. If no remark is entered, the claim will be returned. Direct Data Entry (DDE) has a maximum of 711 positions. Electronic billing software may have other position limitations. |
By following the above instructions, Palmetto GBA will review the remarks entered on the claim. This process will enable Palmetto GBA to determine if the exception can be granted without generating a non-medical additional documentation request (ADR) letter. If there are no remarks, the claim will be Returned to the Provider (RTP) requiring that remarks be entered. If the remarks do not provide enough information, or the remarks provided do not meet the exception criteria, the claim will be rejected with Reason Code 7LATE.
If the exception is granted, it will waive the consequences of filing a NOE late, and the claim will process in accordance with the instructions in CR 8877. If the exception is not granted, the non-covered days will remain non-covered and the remaining service dates will process in accordance with Medicare regulations. Due to a systems limitation, remittance advice (RA) remark code N211 (you may not appeal this decision) will be applied to the provider liable days in error. These days are appealable, and providers may submit a request for a redetermination if they do not agree with Palmetto GBA’s decision. This system limitation will be corrected in a future CR.
Examples of non-qualifying exceptions are as follows:
- Hospice personnel issues
- Internal Information Technology (IT) systems issues that the hospice may experience
- The hospice not knowing the requirements or
- A failure of the hospice to have back-up staff to file the NOE
When not requesting an exception, the hospice shall include the following information on their claim, in addition to all other required claim information:
|
DDE Field |
Description/Valid Values |
|---|---|
|
OSC |
Enter OSC 77 to identify the provider liable non-covered days. The date span should include all days from the admission date until one day prior to the NOE receipt date. |
| CC | No CCs are required. DO NOT use Condition Code 20 on the claim. If used, it will cause the claim to suspend for Medical Review, and an ADR will be generated, which will delay the processing of the claim. |
|
REV CD |
Enter the appropriate level of care and any appropriate discipline revenue code(s) for the dates not covered. Enter a separate line item with the appropriate revenue code(s) for the covered days. |
|
HCPC |
Enter appropriate HCPCS 'Q' code for each level of care line or HCPCS 'G' code for each discipline. |
|
MODIFS |
None |
|
TOT UNT |
For all level of care revenue codes except 0652, the number of units should be the number of consecutive days at that level of care. Units for discipline revenue codes and 0652 should be entered as 15-minute increments (ex: 30 minutes = 2 units). |
|
TOT Charge |
Enter the total charge for each revenue line item. |
|
NCOV CHARGE |
Enter non-covered charges for each line item. |
Example of how to calculate non-covered days:
Admission date is 10/10
- Day 1 = Sat. 10/11
- Day 2 = Sun. 10/12
- Day 3 = Mon. 10/13
- Day 4 = Tues. 10/14
- Day 5 = Weds. 10/15
- 10/15 is the NOE Due Date
If the NOE Receipt date is 10/16, the hospice reports 10/10 through 10/15 as non-covered days using occurrence span code 77.
