- 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
Appropriate Use of Condition Code 85
The Medicare claims processing system requires the OSC 77 be reported on the claim when the physician certification is untimely or when the NOE is submitted untimely. Medicare systems cannot differentiate the two uses of OSC 77 during processing. Currently, claims are rejected in error when the occurrence code 27 falls within the OSC 77 dates and the OSC 77 was used to report an untimely NOE.
As of 1/1/2017, the CMS has developed a new CC, 85, to use when reporting OSC 77 for an untimely certification. The new condition code 85 is defined, “Delayed recertification of hospice terminal illness." When hospices report this code, Medicare systems will ensure the occurrence code 27 date(s) do not fall within the OSC 77 dates when reporting OSC 77 for untimely certification.
Untimely Certification
Effective on and after 1/1/2017 hospices are required to put a CC 85 on the claim with OSC 77 to indicate that there are non-covered provider liable days for an untimely physician certification.
Hospice claims will continue to be RTP if the occurrence code 27 date on a hospice claim falls within the OSC 77 from/through dates, even when the CC 85 is present. The date of the physician certification (OC 27) should not fall within the noncovered provider liable days for a late physician certification.
Untimely Notice of Election
Since October 2014, Medicare regulations require that hospice NOEs shall be filed within five calendar days after the hospice admission date. In instances where a NOE is not timely-filed, Medicare does not cover 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 are a provider liability and the provider may not bill the beneficiary for them. Hospices report OSC 77 to report provider liable non-covered days when the NOE was not submitted within five days. Medicare systems compare incoming hospice claims to the NOE receipt date and enforce the presence of OSC 77 for the appropriate dates.
Effective 1/1/2017, you will not report a condition code 85 on the claim when using OSC77 to indicate an untimely filed NOE. The hospice will only report the OSC 77 with the dates (from and through date) of the non-covered days. If a provider feels that the NOE was untimely but met one of the identified exceptional circumstances continue to put a KX modifier on the first line item with the site of service code.