- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Notice of Election Termination/Revocation
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Tips to Facilitate the Change of Ownership Process
- Service Intensity Add-on Payment
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Appeal for Claims Rejected for an Untimely Hospice Notice of Election
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Correcting Hospice Claims Sequentially to Avoid Reason Code U5181
- Common Working File System Edit F5052 and M5052
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Filing an Electronic Notice of Termination-Revocation of Election (Type of Bill 8XB)
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Notice of Election: Timely Filing of Hospice Elections
- Hospice Claim Submission Job Aid
- Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, VBID Model, Participating MAOs
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Hospice Prescription Drug and Infusion Pump Reporting
- Hospice Caps Job Aid
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Appropriate Use of Condition Code 85
- How to Correct/Avoid Reason Code U5150
- General Inpatient Check Off List
- Hospice Transfers Job Aid
- Medicare Two Tier Routine Home Care Payment Rate
- Canceling a Hospice Notice of Election
- Hospice Pricer Tool Quick Reference Tool
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
- Hospice Payment Rates
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence Span Code 77
Table of Contents
- Background
- Example of the Proper Use of OC 27
- Examples of the Proper Use of OC 27 with OSC 77
- Related Content
Background
Hospice care is available for two periods of 90 days and an unlimited number of subsequent 60-day periods. Certification of the terminal illness is required at the start of each benefit period. The hospice must obtain, no later than two calendar days after the start of each hospice benefit period, oral or written certification of the terminal illness. Initial certifications may be completed up to 15 days before hospice care is elected. For the subsequent periods, recertifications may be completed up to 15 days before the next benefit period begins. If an oral certification is received, the written certification must be on file in the hospice patient’s record prior to submission of a claim to the Medicare contractor.
When the certification/recertification is done timely, occurrence code (OC) 27 is reported on the claim for the billing period that crosses the new/next election period. The OC 27 date must equal the start date of the next election period. Note that the OC 27 date will create the next election period if one is not currently present. The OC 27 is not required to be reported on claims that do not cross a new election period.
When the recertification is not done timely, an occurrence span code (OSC) 77 must be reported to represent for the days that are provider-liable due to the late recertification. The OC 27 is reported with the date that the actual recertification was obtained.
Example of the Proper Use of OC 27
When certifications/recertifications are obtained timely, the OC 27 date reported will match the start date of the election period. For example, the patient is admitted to hospice for the first time on 5/8/20XX and revokes the benefit on 9/6/20XX. The initial certification was done on 5/7/20XX and the recertification was done on 8/6/20XX. The election periods are as follows:
Election Period 1 | Election Period 2 |
---|---|
Start Date: 5/8/20XX | Start Date: 8/6/20XX |
End Date: 8/5/20XX | End Date: 9/6/20XX |
The OC 27 will only be reported on the clams with dates of service that cross the new/next election period.
Claim | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Type of Bill | 8X2 | 8X3 | 8X3 | 8X3 | 8X4 |
Dates of Service | 5/8/20XX–5/31/20XX | 6/1/20XX–6/30/20XX | 7/1/20XX–7/31/20XX | 8/1/20XX–8/31/20XX | 9/1/20XX–9/6/20XX |
OC 27? | Yes | No* | No* | Yes | No* |
OC 27 Date | 5/8/20XX | N/A | N/A | 8/6/20XX | N/A |
*OC 27 is not required to be reported because the claim is not crossing a new hospice election period.
Examples of the Proper Use of OC 27 with OSC 77
When recertifications are not obtained timely, hospices must report OSC 77 to identify the days of care that are not covered by Medicare due to the untimely physician recertification. The OC 27 date reported will match the actual date that the recertification was obtained. Below are two examples of the appropriate use of OC 27 and OSC77.
Example 1: The patient is admitted to hospice for the first time on 10/15/20XX and revokes the benefit on 1/29/20XX. The initial certification was done on 10/15/20XX, and the recertification was done on 1/19/20XX. The election periods are as follows:
Election Period 1 | Election Period 2 |
---|---|
Start Date: 10/15/20XX | Start Date: 1/13/20XX |
End Date: 1/12/20XX | End Date: 1/29/20XX |
The OC 27 will be reported on the initial claim. Since the recertification was obtained late, the OSC 77 will be reported to reflect the days that are not covered by Medicare. The OSC 77 start date will be the first day of the election period where the recertification was obtained late. The OSC 77 end date will be the day before the actual recertification was obtained. OC 27 will then reflect the date that the actual late recertification was obtained.
Claim | 1 | 2 | 3 | 4 |
---|---|---|---|---|
Type of Bill | 8X2 | 8X3 | 8X3 | 8X4 |
Dates of Service | 10/15/20XX–10/31/20XX | 11/1/20XX–11/30/20XX | 12/1/20XX–12/31/20XX | 1/1/20XX–1/29/20XX |
OC 27? | Yes | No* | No* | Yes |
OC 27 Date | 10/15/20XX | N/A | N/A | 10/19/20XX |
OSC 77? | No | No | No | Yes † |
OSC 77 Dates | N/A | N/A | N/A | 1/13/20XX–1/18/20XX |
*OC 27 is not required to be reported because the claim is not crossing a new hospice election period
†OSC 77 is reported to show the provider-liable days due to the late recertification
Example 2: The patient is admitted to hospice for the first time on 9/28/20XX and revokes the benefit on 1/22/20XX. The initial certification was done on 9/18/20XX, and the recertification was done on 1/2/20XX. The election periods are as follows:
Election Period 1 | Election Period 2 |
---|---|
Start Date: 9/28/20XX | Start Date: 12/27/20XX |
End Date: 12/26/20XX | End Date: 1/22/20XX |
The OC 27 will be reported on the initial claim. Since the recertification was obtained late, the OSC 77 will be reported to reflect the days that are not covered by Medicare. When a provider-liable period crosses a billing cycle, the OSC 77 will be reported on both claims that have provider-liable days. Therefore, the OSC 77 start date on the first claim that has provider-liable days will be the first day of the election period where the recertification was obtained late and the end date will be the last day of the billing period. The OSC 77 start date on the second claim will be the first day of the billing period, and the end date will be the day before the actual recertification was obtained. OC 27 will then reflect the date that the actual late recertification was obtained.
Claim | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Type of Bill | 8X2 | 8X3 | 8X3 | 8X3 | 8X4 |
Dates of Service | 9/28/20XX–9/30/20XX | 10/1/20XX–10/31/20XX | 11/1/20XX–11/30/20XX | 12/1/20XX–12/31/20XX | 1/1/20XX–1/22/20XX |
OC 27? | Yes | No* | No* | No** | Yes |
OC 27 Date | 9/28/20XX | N/A | N/A | N/A | 1/2/20XX |
OSC 77? | No | No | No | Yes † | Yes † |
OSC 77 Dates | N/A | N/A | N/A | 12/27/20XX–12/31/20XX | 1/1/20XX–1/1/20XX |
*OC 27 is not required to be reported because the claim is not crossing a new hospice election period.
**OC 27 is not reported because the late recertification was not obtained within the billing period.
†OSC 77 is reported to show the provider-liable days due to the late recertification
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11 Processing Hospice Claims
- More information on hospice claim reporting requirements can be found in the Hospice Claim Submission Job Aid available on our website.