by Find-A-Code™
Aug 3rd, 2015 - Reviewed/Updated May 14th
When a Medicare beneficiary elects hospice services, hospices must complete form locators identified in section 20.1.2 for the Uniform (Institutional Provider) Bill (Form CMS-1450), which is an election notice.
In addition, the hospice must complete the Form CMS-1450 when the election is for a patient who has changed an election from one hospice to another.
Timely-filed hospice NOEs shall be filed within 5 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 5 calendar days after the hospice admission date. While a timely-filed NOE is one that is submitted to and accepted by the Medicare contractor within 5 calendar days after the hospice election, posting to the CWF may not occur within that same time frame. The posting date to the CWF does not reflect whether the NOE is considered timely filed. In instances where a NOE is not timely filed, Medicare 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. The hospice shall report these non-covered days on the claim with an occurrence span code 77, and charges for all claim lines reporting these days shall be reported as non-covered, or the claim will be returned to the provider.
If a hospice fails to file a timely-filed NOE, it may request an exception which, if approved, waives the consequences of filing a NOE late. The four circumstances that may qualify the hospice for an exception to the consequences of filing the NOE more than 5 calendar days after the hospice admission date are as follows:
1. fires, floods, earthquakes, or other unusual events that inflict extensive damage to
the hospice’s ability to operate;
2. an event that produces a data filing problem due to a CMS or Medicare contractor
systems issue that is beyond the control of the hospice;
3. 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,
4. Other circumstances determined by the Medicare contractor or CMS are beyond the control of the hospice.
If one of the four circumstances described above prevents a hospice from filing a timely-filed NOE, the hospice may request an exception which, if approved, would waive the consequences of filing the NOE late.
Even if a hospice believes that exceptional circumstances beyond its control cause its late-filed NOE, the hospice shall file the associated claim with occurrence span code 77 used to identify the non-covered, provider-liable days. The hospice shall also report a KX modifier with the Q HCPCS code reported on the earliest dated level of care line on the claim. The KX modifier shall prompt the Medicare contractor to request the documentation supporting the request for an exception. Based on that documentation, the Medicare contractor shall determine if a circumstance encountered by a hospice qualifies for an exception.
If the request for an exception is approved by the Medicare contractor, the Medicare contractor shall process the claim with the CWF override code and remove the submitted provider liable days, which will allow payment for the days associated with the late-filed NOE. If the Medicare contractor finds that the documentation does not support allowing an exceptional circumstance, the Medicare contractor shall process the claim as submitted.
Hospices must send the Form CMS-1450 Election Notice to the Medicare contractor by mail, messenger, or direct data entry (DDE), depending upon the arrangements with the Medicare contractor. The NOE should be filed as soon as possible after a patient elects the hospice
benefit.
If a patient enters hospice care before the month he/she becomes entitled to Medicare benefits, e.g., before age 65, the hospice should not send the election notice before the first day of the month in which he/she becomes 65.
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