Hospice Billing

Filing an Electronic Notice of Transfer (Type of Bill 8XC)

Table of Contents

[Return to Top]

Filing an Electronic Notice of Transfer (Type of Bill 8XC)

The notice of transfer, TOB 8XC, is submitted when the hospice receives a patient from another hospice during an existing Medicare hospice benefit election period. The notice of transfer should be submitted to Medicare after the transferring hospice has submitted their final claim (8X4). Hospices can submit the notice of transfer via the DDE system, EDI or hard copy (if applicable).

For EDI submissions, Medicare encourages hospices to submit batch transmissions with groups of notices of transfer separate from batch transmissions with groups of claims. This practice may reduce the risk that translator-level rejections related to notices of transfer, if they occur, that could impact payments to the hospice.

Hospices should note notices of transfer submitted via EDI are subject to all front-end edits and may be rejected if all required data is not submitted or does not meet the required elements as outlined in the companion guide provided with CR 10064. Electronically filed notices of transfer will receive a 999 acknowledgment within minutes of submission if accepted. Thus, hospices should also ensure that they monitor their acceptance reports (277CA and 999) at regular intervals. In addition, hospices should be aware that the notice of transfer is subject to the batching process, which means it may be one to two days before the hospice will see the notice of transfer in DDE if it was accepted. Once the notice of transfer is accepted into FISS, processing time may vary as it is subject to all FISS and CWF edits. Therefore, providers are encouraged to also monitor the status of the notice of transfer in DDE to ensure they make any corrections that may be necessary should the notice of transfer be RTP for correction.

To complete the 8XC in DDE, select menu option ‘28’ from the claims entry menu. For submission of the notice of transfer via EDI, follow your software instructions. The table below provides the fields that must be completed when submitting the notice of transfer via DDE, EDI, or hard copy (if applicable). Note: There are additional fields that will be required when submitting the notice of transfer via EDI.

Field Descriptor DDE EDI **Hard Copy (UB-04 by Field Locator [FL]) Description/Valid Values
Provider Name, Address and Telephone Number X X X
(FL 1)		 The DDE system will auto-populate this information based on the NPI that is used for submission of the Notice of Transfer.

For electronic submission through EDI, check with your software vendor to determine where this information is stored or if you will need to manually enter the information on the claim.
Type of Bill X
(TOB)
Claim Page 01		 X X
(FL 4)		 Enter the type of bill for the NOEValid values are:
  • 81C (Freestanding hospice: ‘81’ is system generated)
  • 82C (Hospital-based hospice: provider keyed)
Statement Covers Period (‘FROM’ Date) X
(STMT DATES FROM)
Claim Page 01		 X X
(FL 6)		 Enter the effective date hospice enrollment with your agency in MM/DD/YY.

This date must match the Admit Date and the date reported with Occurrence Code 27.
Statement Covers Period (‘THROUGH’ Date) X
(STMT DATES TO)
Claim Page 01		 X X
(FL 6)		 Enter the effective date of hospice enrollment in MM/DD/YY.

The date entered should match the date in the 'FROM' date field.
Patient’s Name X
(Last, First, MI) Claim Page 01		 X X
(FL 8)		 Enter the patient’s name as shown on the eligibility file with the surname first, first name, and middle initial (optional), if any.
Patient’s Birth Date X
(DOB)
Claim Page 01		 X X
(FL 10)		 Enter the patient’s date of birth in MMDDYYYY format.
Patient’s Address X
(ADDR 1 – 6 and ZIP)
Claim Page 01		 X X
(FL 9)		 Enter the patient’s full mailing address including street name and number, post office box number or RFD, city, state and ZIP code.
Patient’s Sex X
(SEX)
Claim Page 01		 X X
(11)		 Enter the patient’s sex. Valid values are:
  • M (Male)
  • F (Female)
Admission Date X
(ADMIT DATE) Claim Page 01		 X X
(FL 12)		 Enter the hospice admission date with your agency.

This date must match the 'FROM' date in the Statement Covers Period and the date reported in Occurrence Code 27.
Type of Admission   X   Enter a valid Type of Admission Code (1 – 9).
Admission Source Code   X   Enter the Source of Admission with the default value of ‘1.’
Patient Status Code   X   Enter the patient discharge status code with the default value of ‘30.’
Occurrence Codes and Dates X
(OCCCDS/Date — 01-10)
Claim Page 01		 X X
(FL 31 – 34)		 Enter Occurrence Code (OC) “27” and the certification date if the transfer takes place on the date the recertification is due.

When applicable, this date must match the Statement “FROM” and “ADMIT” dates.
N/A X
(FAC. ZIP)
Claim Page 01		     The entire nine-digit ZIP Code must be entered and should match the facility’s master address in the provider enrollment record (usually the facility’s physical location).
Revenue Code   X   Enter the default revenue code 0650.
HCPCS   X   Enter the default HCPCS code Q5009.
Service Date   X   Enter the service date that matches the ‘FROM’ date in the Statement Covers Period.
Total Units   X   Enter the default total units of ‘1.’
Total Charges   X   Enter zeros (0.00)
Payer ID Code X
(CD)
Claim Page 03		 X   Line A – ‘Z’ is system generated in DDE.

Claims submitted via EDI will depend upon the software being used. If the software does not auto-populate this field, enter the ‘Z’ to reflect Medicare as the payer source.
Payer X
(PAYER)
Claim Page 03		 X X
(FL 50)		 Line A – ‘Medicare’ is system generated in DDE.

Claims submitted via EDI will depend upon the software being used. If the software does not auto-populate this field, enter ‘Medicare.’
Insured’s Name X
Claim Page 03		 X X
(FL 58)		 Enter the beneficiary’s name on line A as it appears on the beneficiary’s HI card.

Note: All Notice of Transfers are submitted with Medicare as the primary payer.
Certificate/Social Security Number and Health Insurance Claim/Identification Number X
MBI
Claim Page 01		 X X
(FL 60)		 Enter the beneficiary’s MBI.

In DDE, this is entered on Claim Page 1.

For claims submitted via EDI, this field may vary depending upon the software used. Check with your vendor if assistance is needed.
Release of Information X
(RI)
Claim Page 03		 X X
(FL 52)		 The Release of Information Certification Indicator indicates whether the provider has on file, a signed statement permitting the provider to release data to other organizations in order to adjudicate the claim. Valid values are:
  • I - Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes.
  • Y - Yes, provider has a signed statement permitting release of information.
Principal Diagnosis Code X
(DIAG CODES 01 – 09)
Claim Page 03		 X X
(FL 66)		 Enter all diagnoses as appropriate.
Attending Physician I.D. X
Claim Page 03		 X X
(FL 76)		 Enter the NPI and name of physician currently responsible for certifying the terminal illness and signing the individual’s plan of care.
Other Physician I.D. X
(REF PHYS)
Claim Page 03		 X
(Referring)		 X
( FL 78)		 Enter the NPI and name of the hospice physician responsible for certifying the patient’s terminal illness.

Note: When the hospice physician is the attending and certifying physician, only the attending physician NPI is required to be reported.
Provider Representative Signature and Date     X
(FL 80)		 A hospice representative must make sure the required physician’s certification and a signed hospice election statement are in the records before signing the Form CMS-1450. A stamped signature is acceptable.

[Return to Top]

Correcting the Transfer Date on a Previous Submitted Notice of Transfer

An erroneous Notice of Transfer date on the NOE can only be corrected for an admission that occurred on or after 1/14/2018.

*Example of submitting a corrected 8XC:

Initial 8XC was submitted with a Notice of Transfer date of 01/08/XX. The actual Notice of Transfer date was 01/07/XX. The hospice reports the following:

Type of Bill (TOB 8XC
Statement Covers Period Enter 0107XX in the “FROM” date field
Statement Covers Period Enter 0107XX in the “THROUGH” date field if the 8XC is being submitted through EDI. Leave this field blank if the 8XC is being submitted via DDE
Admission Date Enter 0107XX
Condition Code Enter “D0” (ensure that the number zero is entered)
Occurrence Code and Date Enter Occurrence Code “27” and 0107XX (correct Admit date)
Occurrence Code and Date Enter Occurrence Code “56” and 0108XX (incorrect Admit date)

 

Billing the 8XC When the Transferring Hospice Transfers a Beneficiary on the Last Day of a Benefit Period and the Receiving Hospice Admits on the First Day of a New Benefit Period.

Hospice transfers may occur over two consecutive days, where the transferring hospice transfers a beneficiary one day, and the receiving hospice admits on the next. However, system limitations will not allow the 8XC to process if submitted with first day of a new period as the admission, “FROM” and “THROUGH” dates when the transferring hospice transfers a beneficiary from their care on the last day of a period. The 8XC will RTP for U5106.

In order to avoid the RTP, receiving hospices shall bill the 8XC with the last day of the previous period as the admission, “FROM” and “THROUGH” dates. The sequential claim that follows the transfer should reflect the actual admission, “FROM” and “THROUGH” dates the receiving hospice admitted the beneficiary, i.e., the first day of the new period. These instructions will ensure accurate claim payment and avoid an overpayment.

*Hardcopy UB-04 Claims may only be submitted by providers that are authorized to do so

[Return to Top]

Related Content