Hospice Billing

How to Correct/Avoid Reason Code U5150

When a Medicare hospice eligible individual elects hospice, the hospice must submit a NOE to the Medicare contractor prior to submitting claims for payment. The NOE transmits the hospice information to the CWF. Once the initial NOE is processed (status/location P B9997), CWF maintains the beneficiary in hospice status (until death or until an election termination is received) and the hospice can begin submitting claims for payment.

If the NOE is not processed prior to submitting the first claim, the claim will be RTP with reason code U5150. The FISS reason code U5150 the narrative states, “Hospice claim received and no hospice master record present for this beneficiary.”

How to Correct This Reason Code

Check the FISS Claims Inquiry file to verify the NOE has been processed and appears in status/location (S/LOC) P B9997 prior to resubmitting the claim. To access the Claims Inquiry file from the FISS/DDE Provider Online System, follow these steps:

Step Action
1 From the FISS Main Menu, Key 01 (Inquiries) in the ENTER MENU SELECTION field
2 <Enter> The Inquires Menu will be displayed
3 Key 12 (Claims) in the ENTER MENU SELECTION field
4 <Enter> The initial CLAIM SUMMARY INQUIRY Screen will be displayed

 

To perform searches within the CLAIMS SUMMARY INQUIRY option, type any of the following criteria to obtain a list of claims (Note: At a minimum, either the MBI or the status/location must be included in your claim search):

Field Description
NPI Enter your ten-digit NPI
MBI Enter the MBI for the beneficiary
PROVIDER Enter your provider number
S/LOC Enter the status/location (e.g., P B9997)
TOB Enter the bill type (e.g., 811)
OPERATOR ID Enter the operator identification number of the person who keyed the claim
FROM DATE Enter a specific From date in MMDDYY format
TO DATE Enter a specific Thru date in MMDDYY format

 

If the NOE has not been submitted yet, submit it and wait for it to finalize prior to resubmitting the claim. Remember the NOE must be processed before resubmitting your claim.

How to Avoid This Reason Code

The NOE should be filed as soon as possible after a patient elects the hospice benefit. By submitting the NOE timely, other providers will see that the patient is in the Medicare hospice benefit. This helps to avoid inappropriate billing to Medicare contractors by non-hospice providers, and can help to avoid inappropriate billing by other hospices.

The NOE must be submitted and processed prior to submitting the first hospice claim to Medicare. Once the NOE is processed, the hospice can begin submitting claims to National Government Services for payment. Never submit an NOE and claim on the same day, and always check the claims system to make sure that the NOE is submitted and processed before submitting any claims to Medicare.

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