- 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
Filing an Electronic Notice of Termination-Revocation of Election (TOB 8XB)
The NOTR, TOB 8XB, is submitted when the hospice discharges the beneficiary or the beneficiary chooses to revoke the Medicare hospice benefit if the hospice has not already filed a final claim. The NOTR (8XB) or final claim (8X4) must be filed within five days of the effective date the beneficiary is discharged or revoked. Effective on or after 7/1/2018, the NOTR may be submitted to post a revocation date on an open election period established in the CWF. Hospices can submit the NOTR via the DDE system, EDI or hard copy (if applicable).
While it is preferred that you file a final claim instead of a NOTR, there are certain situations that may still require the NOTR. As an example, some final claim rejections or denials may not post the revocation on the CWF.
For EDI submissions, Medicare encourages hospices to submit batch transmissions with groups of NOTRs separate from batch transmissions with groups of claims. This practice may reduce the risk that translator-level rejections related to NOTRs, if they occur, that could impact payments to the hospice.
Hospices should note NOTRs 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 NOTRs will receive a 999 acknowledgment within minutes of submission if accepted. Thus, hospices should also ensure they monitor their acceptance reports (277CA and 999) at regular intervals. In addition, hospices should be aware that the NOTR is subject to the batching process, which means it may be one to two days before the hospice will see the NOTR in DDE if it was accepted. Once the NOTR is accepted into FISS, processing time may vary as it is subject to all FISS and CWF edits. Therefore, you are encouraged to also monitor the status of the NOTR in DDE to ensure you make any corrections necessary should the NOTR be RTPd for correction.
To complete the 8XB, select menu option ‘49’ from the claims entry menu in DDE. For submission of the NOTR via EDI, follow your software instructions. The table below provides the fields that must be completed when submitting the NOTR via DDE, EDI or hard copy (if applicable). Note: There are additional fields that will be required when submitting the NOTR 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 NOTR. 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 NOTR. Valid values are:
|
| Statement Covers Period (‘From’ Date) | X (STMT DATES FROM) Claim Page 01 |
X | X (FL 6) |
Enter the start date of the hospice benefit period in which the discharge or revocation is effective in MM/DD/YY format. This would be the same FROM date as submitted on the NOE, TOB 8XA if a transfer or notice of change did not occur after the beneficiary elected the Medicare hospice benefit. If the beneficiary transferred after electing the Medicare hospice benefit, the date must match the Start Date 2 of the benefit period in which the transfer took place. This would be the same FROM date as submitted on the Notice of Transfer, TOB 8XC. If there was a Notice of Change of Ownership, TOB 8XE billed, then the FROM date would need to match the date on the 8XE. |
| Statement Covers Period (‘Through’ Date) | X (STMT DATES TO) Claim Page 01 |
X | X (FL 6) |
Enter the date of discharge/revocation in MM/DD/YY format. |
| 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:
|
| Admission Date | X (ADMIT DATE) Claim Page 01 |
X | X (FL 12) |
Enter the start date of the hospice benefit period in which the discharge or revocation is effective, not the initial hospice admission date. This date should match the FROM date submitted on the NOE, TOB 8XA if the beneficiary did not transfer after electing the Medicare hospice benefit. If the beneficiary transferred after electing the Medicare hospice benefit, enter the Start Date 2 of the benefit period in which the patient transferred. This date should match the FROM date submitted on the Notice of Change, TOB 8XC. If there was a Notice of Change of Ownership, TOB 8XE billed, then the FROM date would need to match the date on the 8XE. |
| 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.’ | ||
| Condition Codes | X (COND CODES 01 - 10) Claim Page 01 |
X | X (FL 18 – 28) |
*Enter D0 (the number zero) if the NOTR is correcting a discharge/revocation date. Note: when D0 is entered on the claim, OC 56 and date must also be submitted. If both codes are not submitted on the NOTR, it will be returned to the provider. |
| Occurrence Codes and Dates | X (OCC CDS/Date 01 – 10) Claim Page 01 |
X | X (FL 31 – 34) |
To correct a discharge or revocation date previously submitted on an NOTR in error, enter OC 56 and the discharge/revocation date reported on the original NOTR in the ‘through’ date field. *The ‘through’ date on a corrected NOTR will reflect the correct discharge/revocation date. Note: When OC 56 is submitted on the NOTR, CC D0 must also be entered. If both codes are not on the NOTR, it will be returned to the provider. |
| 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). | ||
| Provider Number | X (NPI) Claim Page 01 |
X | X (FL 56) |
Enter the NPI associated with the OSCAR number. |
| N/A | X (OSCAR) Claim Page 01 |
The system will automatically prefill the Medicare OSCAR number (the six-digit number assigned by Medicare) when logging on to the DDE system. | ||
| 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 autopopulate 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 NOTRs 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 Medicare ID number. 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:
|
| 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. |
| Remarks | X | X | X (FL 80) |
Enter the reason for discharge. Include your initials and the date the remark was entered. You can use the discharge situations below to determine the appropriate remarks. |
| 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. |
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.
*Below is an example of submitting a corrected NOTR. This example is for demonstration purposes only.
Initial NOTR was submitted with a “THROUGH” date of 01/22/XX. The actual discharge date is 01/21/XX. The hospice reports the following:
| TOB: | 8XB |
|---|---|
| Statement Covers Period | Enter 0101XX in the ‘from’ date field |
| Statement Covers Period | Enter 0121XX in the ‘through’ date field (correct discharge date) |
| Admission Date | Enter 0101XX |
| Condition Code | Enter D0 (ensure that the number zero is entered) |
| Occurrence Code and Date | Enter OC 56 and 0122XX (incorrect discharge date) |
There are also times when a provider may submit an NOTR in error. Previously, CMS had instructed providers that they could remove an NOTR that was filed in error by submitting a corrected NOTR using all zeros (000000) in the “THROUGH” date field. However, subsequent to the updates, CMS and the Medicare Administrative Contractors (MACs) learned that the process to remove an NOTR using the zeros in the “THROUGH” date field did not work.
To remove an NOTR that was filed in error, providers will need to follow the steps outlined below:
- Cancel the final claim – if the final claim has not yet been submitted, you will need to submit it with the “THROUGH” date as the date that was submitted on the NOTR. Once the final claim has processed, initiate a cancelation claim.
- Check the HOEP screen to see if the revocation date and indicator were removed. If the revocation date and indicator have been removed, proceed with resubmitting the final claim. If the revocation date and indicator are not removed, proceed to step 2 below.
- Cancel all claims in the benefit period in which the NOTR ended the hospice election.
- After all claims in the benefit period have been canceled, check the HOEP screen again. If the revocation date and indicator have been removed, proceed with resubmitting the claims in sequential order. If the revocation date and indicator are not removed, proceed to step 3 below.
- Cancel the NOE. This will remove the entire election period and will need to be resubmitted. Once the NOE has been canceled, you will need to resubmit it within 2 business days after the cancelation was completed. Upon resubmitting the claims in sequential order, you will need to request an exception to the late NOE based upon the system limitations that would not allow you to remove the NOTR that was submitted in error.
Note: In most cases, the MACs have found that the NOE only has to be canceled if start date of the benefit period in which the beneficiary/patient was discharged or revoked is the same as the hospice election date.
**Hardcopy UB-04 Claims may only be submitted by providers that are authorized to do so.