Timely Filing of Hospice Notice of Elections (NOEs) and Notice of Terminations/Revocations (NOTRs) Questions and Answers

Resources
Change Request 8877 (PDF)
Hospice Billing When a Notice of Election (NOE) was Filed Untimely Job Aid
MLN Matters Number: SE18007 (PDF)
Hospice Notice of Election • TOB 8XA (PDF)
Hospice Notice of Termination/Revocation of Election • TOB 8XB (PDF)

This question and answer article is intended for hospices submitting claims to Home Health and Hospice Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries. It provides education for the required timeframes for filing a hospice Notice of Election (NOE) and Notice of Termination/Revocation of Election (NOTR).
 
Question: Does the required timeframes for filing a hospice notice of election, and a hospice notice of termination/revocation of election, explained in Change Request (CR) 8877, affect claims for dates of service prior to October 1, 2014?

Answer: CR 8877 applies to all claims and any new admissions and live discharge/revocations that occur on/after October 1, 2014.

Question: The CR says that the NOE must be “submitted to, and accepted by” the Medicare Administrative Contractor (MAC) to meet the five-day requirement. The date of posting to the Common Working File (CWF) is not a reflection of whether the Notice of Election (NOE) is considered timely filed? A provider can monitor their date for NOE submission, but how will we determine the date of “acceptance?” Is there a certain code that a hospice needs to monitor for, or will they be safe as long as the NOE does not return to provider (RTP)? What is an acceptable turnaround; simultaneously with the submission date or is there a delay?

Answer: The NOE/NOTR must be free of any billing and/or keying errors in order to be accepted. When the NOE is submitted, the Fiscal Intermediary Shared System (FISS) will assign a receipt date (REC DT) to the NOE. However, if an error is identified on the NOE (billing/keying error), or the NOE edits against an open hospice benefit period, or other beneficiary eligibility information, it will RTP or rejected. If an NOE RTPs, it will receive a new REC DT when it is corrected. This new REC DT will be the date used to determine whether the NOE was submitted timely.

Nonetheless, if errors are identified on the NOE (billing or keying error), the NOE edits against an open hospice benefit period or additional beneficiary eligibility information, the claim will RTP or reject. 

Question: If a Hospice identifies an error while processing an NOE, do they have to wait for it to RTP to correct the mistake?

Answer: No. Hospices do not need to wait for the initial NOE to RTP. Submitting a new, corrected NOE when the error is identified may reduce the risk of having an untimely NOE. However, if the initial NOE processes without returning, the new NOE will not process. This situation would not qualify as an exceptional circumstance.

Some NOE and NOTR billing errors may be fixed without cancelling a processed/approved NOE/NOTR, as discussed in MLN Matters Number SE18007, Recent and Upcoming Improvements In Hospice Billing and Claims Processing. In the past, if a hospice made an error in the election date on an NOE (Type of Bill (TOB) 8xA), the hospice had to cancel the incorrect election (using TOB 8xD) and then submit a replacement NOE.

This would correct the election date in the Medicare system, but the original NOE receipt date would be lost. When the replacement NOE was processed, it often appeared that it was submitted after the 5 day timely filing period. As a result, the need to request an exception to the NOE timely filing requirement became an administrative burden for stakeholders.

An erroneous admission date on or after January 1, 2018, the hospice can submit another TOB 8XA, using the correct election dates to include the From, Admission date and Occurrence Code 27 to correct the election date. In addition, the hospice must submit the original, incorrect election date on the 8xA using Occurrence Code 56. Medicare systems use this date to find the election record that needs to be corrected. Once it is found, it replaces the election date with the corrected information. The hospice must also indicate the NOE is a correction by adding Condition Code D0 (zero).

Question: If a patient revokes and re-elects a few days later with the same hospice, how should this be billed?

Answer: The hospice must bill sequentially and must comply with the five-day billing election/revocation regulations. Therefore, the NOTR or final claim must be filed on or before the date the readmission NOE is filed. Hospices can file an NOTR as early as the day after revocation/discharge (providers may not want to file on the date of discharge in case the patient returns later that day) to help eliminate late filing issues if there is a readmission in the future.

Question: How does a hospice file for an exception?

Answer: Palmetto GBA has developed a job aid “Hospice Billing When an NOE was Filed Untimely.” The job aid will provide instructions on how to file an exception.

Question: If we are aware that a prior hospice benefit period had not been terminated at the time of our admission, should we still submit our NOE within the five-day timely filing period?

Answer: Yes. The NOE will RTP. The internal audit trail will show it was initially submitted in a timely manner. The provider is responsible for documenting their attempts to work with the previous hospice and resubmit the NOE as soon as the revocation indicator is updated on the CWF. Once the NOE is processed and posted to the CWF, the hospice may submit the claim and request an exception as instructed in the “Hospice Billing When a Notice of Election (NOE) was Filed Untimely” job aid. When the claim is submitted with the required data to request an exception, the claim must also include remarks to support the hospice’s contact and/or attempts to contact the prior hospice.

Question: What other circumstances will Palmetto GBA determine to be beyond the control of the hospice?

Answer: Additional exceptions will be evaluated on a case by case basis. The exception is considered a “lite” appeal. Exceptions that are denied may be appealed using the standard appeals process. If the exception is complex, to include but not limited to, missing relative information and/or needs documentation to make a decision, it will likely be denied and an appeal would need to be submitted.

Question: What process should be followed when an NOE has to be changed after it is initially filed? For example, if the attending physician or principle hospice diagnosis changes soon after admission. Will the initial filing of the NOE be "retained" in the system so that when a revised NOE is filed the five-day edit will not be a problem or would any corrections be made on the first claim?

Answer: If the information has changed or a keying error occurred with the certifying physician or diagnosis code, you do not need to cancel the NOE. Corrections to diagnosis codes and certifying physicians on the NOE may be made on subsequent claims. Since there is no editing in Medicare systems that ensures the diagnosis codes and certifying physicians on hospice claims match the NOE, hospices may correct diagnosis coding and certifying physician’s errors on subsequent claims without canceling the NOE.

Question: If we are requesting an exception, will Palmetto GBA generate a non-medical additional documentation request (ADR) letter?

Answer: No. Providers should enter the exception reason in the claim’s remark field. If remarks are not present to include enough information or the remarks provided does not meet the exception criteria, the claim will be rejected with Reason Code 7LATE. Please refer to the “Hospice Billing When a Notice of Election (NOE) was Filed Untimely” job aid for more information.

Question: Is an 8xB the correct TOB for both the Notice of Termination and Notice of Revocation?

Answer: Yes.

Question: Will the submission of a Notice of Termination/Revocation (NOTR) prohibit a final claim from being processed at a later date?

Answer: No. The filing of an NOTR will not prevent a final claim from processing; assuming dates on the final claim are not beyond the termination/revocation date that is specified on the NOTR.

Question: Will a NOTR process if the discharge/revocation occurs during a benefit period that has not yet been established at the CWF?

Answer: Yes. The MLN Matters article SE18007 discusses the redesign and NOTRs may now be submitted at any time. Hospices should not wait to submit the sequential claims that are required to discharge the patient unless they are awaiting documentation that is required before they can submit the claim.

As a reminder, the NOTR only has to be submitted if the final claim has not yet been submitted. If the final claim can be submitted as soon as the next benefit period has posted to CWF, the provider should submit the final claim. The NOTR is not required in this instance.   

Question: Does timely filing of final claims/NOTRs apply to a patient that dies under that hospice benefit?

Answer: No. The five-day submission timeframe of final claims and NOTRs only applies to live discharges.

Question: Does CR 8877 include hospice transfers?

Answer: No. A transfer is a continuation of a hospice benefit period and an 8XC is not held to the five-day submission timeframe. Receiving agencies should remember that an 8XC does not get submitted until after the transferring provider has finalized their billing.

Question: Does CR 8877 include regulations for changes of ownership (CHOW)?

Answer: For a change of ownership (CHOW), NOEs and sequential claims should continue to be submitted timely. The seller and buyer should agree to continue billing until the CHOW finalizes. NOEs dated prior to the effective date of the CHOW do not need to be cancelled. Exceptions for late NOEs after the CHOW effective date may be approved on a case by case basis.

Question: What information must be reported on a NOTR (type of bill {TOB} 81B or 82B)?

Answer: Palmetto GBA has developed the “Hospice Notice of Termination/Revocation of Election — TOB 8XB” job aid to guide providers through the reporting requirements of a NOTR. The job aid includes instructions for correcting the discharge date on a previous submitted NOTR and how to remove a revocation date established by an NOTR submitted in error.

Question: According to section 20.1.1, Chapter 11 of the Medicare Claims Processing Manual (CMS Pub. 100-04), hospices must send Form CMS-1450, Election Notice to the Medicare contractor, by either mail, messenger or direct data entry (DDE) depending upon the arrangements with the Medicare contractor. What are the terms of agreement for hospices to submit their NOEs to Palmetto GBA by mail or messenger?

Answer: Palmetto GBA requires all hospices to submit their NOEs through DDE electronically. Paper (hard copy) NOEs are not acceptable unless the agency has applied for and received approval to submit paper claim forms in accordance with the Administrative Simplification Compliance Act (ASCA). The Act prohibits Medicare coverage of claims submitted to Medicare on paper; the exception does apply in limited situations. Please refer to the Medicare Claims Processing Manual (CMS Pub. 100-04), Section 90, Chapter 24 for more information about the Mandatory Electronic Submission of Medicare Claims.

Question: I lost my DDE access and have applied for a new ID. Can I submit my NOEs on paper until my new ID is issued?

Answer: Palmetto GBA can only accept paper (hard copy) NOEs if the hospice has applied for and received approval to submit paper claim forms in accordance with ASCA. ASCA prohibits Medicare coverage of claims submitted to Medicare on paper, except in limited situations.

Prior to January 1, 2018, the hospice could only submit NOEs using paper claim forms or key-entering the NOE information into the DDE screens. Effective January 1, 2018, Medicare began to accept NOEs and other related transaction data using a non-standard implementation of the 837I claim transaction via the Electronic Data Interchange (EDI). Medicare published a companion guide for NOE transmissions in the Downloads section of the CMS Hospice Services website.