Hospice Billing

Hospice Notice of Election Termination/Revocation

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Hospice Notice of Election Termination/Revocation

Upon discharge from hospice or revocation of hospice care, the beneficiary immediately resumes the Medicare coverage that had previously been waived by the hospice election. As such, hospices should promptly record the beneficiary’s discharge or revocation in the claims processing system. Doing so protects the beneficiary from experiencing possible delays in accessing needed care.

With the implementation of CR 8877 for claims with dates of service on or after 10/1/2014, when a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, hospice providers are now required to submit a timely-filed NOTR using TOB 8XB, unless it has already filed a final claim.

A timely-filed NOTR is an NOTR submitted to the Medicare contractor and accepted by the Medicare contractor within five calendar days after the effective date of discharge or revocation. A timely-filed NOTR is a NOTR with a receipt date within five calendar days after the hospice discharge/revocation date and is subsequently processed in status/location P B9997. Hospices continue to have 12 months from the date of service in which to timely file their claims.

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Examples of NOTR Time Frames

  • Timely NOTR: A patient revokes the hospice benefit on 10/8/20XX. The NOTR is submitted on 10/13/20XX and ultimately processes on 10/17/20XX.
  • Untimely NOTR: A patient revokes the hospice benefit on 10/8/20XX. The NOTR is submitted on 10/13/20XX and is RTP on 10/14/20XX due to a billing error. The NOTR is resubmitted on 10/17/20XX and ultimately processes on 10/21/20XX.
    • Currently, there is no financial implication for late NOTRs; therefore, there is no special coding required if the NOTR is not submitted timely. However, be advised a final claim or NOTR is not submitted within five days of the discharge or revocation and the beneficiary readmits, this could impact the ability to timely submit a NOE. An untimely NOE for a readmission when a final claim or NOTR within five days may not meet for an untimely filed NOE exceptional circumstance.

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Reminders/Notes on the NOTR

The submission of the NOTR will not prevent the final claim from processing. The purpose of the NOTR is to ensure that the CWF is updated quickly so other providers may begin to bill Medicare for services, prior to submitting the hospice final claim. This will give the hospice providers time to gather all of the information in order to submit a complete final claim.

The NOTR is not submitted if the:

  • patient dies or transfers to another hospice. The NOTR is only used for live discharges from the Medicare hospice benefit or revocations.
  • hospice submits the final claim within five calendar days after the date of discharge/revocation.

The NOTR will RTP if the revocation/termination date does not match a benefit period posted to the CWF. In order for an NOTR to process, the benefit period in which the patient was discharged has to be established in the CWF. For example, if the beneficiary revokes or is discharged on 11/2, but the current benefit period posted in the CWF ends on 10/27, the claim for the October billing period must be submitted to get the subsequent benefit period posted to the CWF before an NOTR will process.

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 and the NOTR is not required. In the example above, the final claim for 11/1–11/2 could be submitted as soon as the benefit period beginning 10/28 is posted to CWF. If the claim cannot be submitted as soon as the 10/28 benefit period has posted to CWF, the NOTR should be submitted.

If you submit an incorrect NOTR, there is a process to remove it from CWF. This process works when only one election period has to be removed. First, you will have to cancel all claims within the election period in question. After all claims have been cancelled, submit an 8XD with the start date of the election period in question. Once the 8XD is finalized, this will remove the election period in CWF. You can then begin resubmitting your claims as appropriate. Note if additional election periods are involved, you will have to work with the PCC for assistance.

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Correcting a Discharge Date on a NOTR After 1/1/2018

An erroneous discharge date on the NOTR can only be corrected for a discharge that occurred for an admission date on or after 1/1/2018. Conditions codes are not required on an original NOTR. Hospice may submit an NOTR that corrects a revocation date previously submitted in error. In this case, the hospice reports the correct revocation date in the Through Date Field and reports the original revocation date using occurrence code 56.

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Diagnosis Codes

Diagnosis codes are not required on NOTR; however, you should be aware if a diagnosis code is reported in the DIAG CODE field on page 3 of the FISS on a NOTR (TOB 81B or 82B), FISS will check to ensure the ICD-9 or ICD-10 code is valid. If an invalid code is used or an ICD-9 code after 10/1/2015 the claim will RTP.

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Submitting an NOTR via FISS/DDE

Steps Task
1 Log into the FISS
2 Access the FISS Main Menu
3 Key 02 in the ENTER MENU SELECTION field
4 <Enter> then the Claims and Attachments Entry Menu will be displayed
5 Key 49 in the ENTER MENU SELECTION field
6 < Enter > then the INST Claim Entry Menu will be displayed

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Claim Page One

Field Description/Valid Values
MBI (Required) Enter MBI
TOB (Required) Enter the type of bill for the NOTR. Default is 8XA and must be changed to one the following valid values:
  • 81B (Freestanding hospice: system generated)
  • 82B (Hospital-based hospice: provider keyed)
OSCAR (System) The Medicare provider number (OSCAR number) is system generated.
NPI (Required) Enter the NPI associated with the OSCAR number.
STMT DATES FROM (Required) Enter the start date of the hospice benefit period in which the discharge or revocation is effective in MMDDYY format.
STMT DATES TO (Required) Enter the date of revocation or discharge in MMDDYY format.
PATIENT DATA (Required) Enter the beneficiary’s last name, first name, date of birth (MMDDCCYY), full mailing address, ZIP Code, and gender.
ADMIT DATE (Required) Enter the start date of the hospice benefit period in which the discharge or revocation is effective in MMDDYY format. Do not enter the initial hospice admission date.
FAC. ZIP (Required) Enter the facility ZIP Code of the provider (five- or nine-digit).

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Claim Page Three

Field Description/Valid Values
CD (System) “Z” is system generated. Do not change.
PAYER (System) “Medicare” is system generated. Do not change.
RI (Required) Enter the release of information indicator. Valid values are:
  • “Y” to indicate you have a signed statement on file permitting you to release data to other organizations to adjudicate claims.
  • “R” to indicate the release is limited or restricted.
  • “N” to indicate there is no release is on file.

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