Hospice Transfers Job Aid
When an individual elects the Medicare hospice benefit, he or she must file an election statement with a particular hospice. Upon election, the individual waives rights to Medicare payments for hospice care provided by a hospice other than the hospice designated by the individual. However, an individual or representative may change, once in each election period, the designation of the particular hospice from which hospice care will be received.
Each hospice is permitted to bill for the day of transfer, and each will be reimbursed at the appropriate level of care for its respective day of discharge or admission. The transfer must occur on the same day with no gap in service dates. There cannot be a gap in billing (i.e., there cannot be more than one day between the transferring agency’s final claim ‘through’ date and the receiving agency’s effective date). A claim with a gap in service days will return to the provider. The change of the designated hospice is not a revocation of the election. It is a continuation of the current benefit period.
To change the designation of the hospice, an individual or representative must file a statement or transfer agreement that includes the following information:
- The name of the hospice from which the individual has received care and the name of the hospice from which he or she plans to receive care; and
- The date the change is to be effective.
- The signature of the beneficiary or their representative.
Note: The signed statement or transfer agreement must be filed with both the transferring and receiving agencies.
Did You Know?
When a hospice transfer occurs in the patient’s third or later benefit period, the transferring hospice will need to provide the documentation of the face-to-face encounter to the receiving agency.
More information on the face-to-face encounter requirements can be found in the CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance, Section 20.1.
Billing
The transferring agency will submit a final claim indicating the transfer (see Transferring Agency below). Once the transferring agency’s final claim is processed, the receiving hospice then submits a notice of change/transfer to the intermediary (see Receiving Agency below).
The notice of change/transfer transmits the information to the CWF. The CWF maintains the beneficiary in hospice status and updates the designated hospice information.
Transferring Agency
The hospice that the patient is transferring from must submit their final claim before the receiving agency can submit their notice of change/transfer. Since this is not a discharge from the hospice benefit but rather a transfer to another agency, do NOT include an occurrence code 42. The occurrence code 42 discharges the patient from the hospice benefit in the Common Working File.
In addition to the basic claim information that is required on all claims, the final claim must include the following:
Claim Page One
| Field | Description/Valid Value |
|---|---|
| TOB | Valid Values:
|
| STAT | Valid Values:
|
Do not include an occurrence code 42 as this would discharge the patient from the hospice benefit.
Claim Page Four
| Field | Description/Valid Value |
|---|---|
| REMARKS | Enter remarks explaining the transfer including the name, address and provider number (if available) of the agency the patient is transferring to along with the effective date of the transfer. |
Receiving Agency
The hospice that the patient is transferring to submits a NOC prior to submitting claims for payment. This notice is also known as a notice of transfer. The intermediary then transmits the information to the CWF indicating that the admission to the receiving agency is a continuation of the current election period. The CWF maintains the beneficiary with the new hospice until death or until an election termination is received.
The NOC must be submitted after the transferring hospice agency has submitted their final claim. All hospice claims/notices must be submitted and processed in sequence to maintain the integrity of hospice election periods. Communication between the two agencies is extremely important. The discharging agency should contact the receiving agency to let them know when the discharge claim is processed. The receiving agency can also check the CWF to determine if the discharge claim has been processed by looking at the DOLBA DATE in the hospice record. Providers can access CWF in FISS through HIQA.
There are times when an agency may not work with the other agency. We ask that agencies always try to work it out with the other agency first. Make sure to document all of your contact attempts. If all attempts to work the billing out with the other agency fail, you may call the Provider Contact Center to assist with the transfer dispute.
The NOC is an abbreviated claim; therefore, only a few of the many form locators on the UB-04 are required. Also, payment is not applied to the NOCs.
Submitting the NOC Electronically
Steps
- From the FISS Main Menu, Key 02 in the ENTER MENU SELECTION field
- < Enter > The Claims and Attachments Entry Menu will be displayed
Screen
Steps
- Key 49 in the ENTER MENU SELECTION field
- < Enter > The INST Claim Entry Menu will be displayed
NOC Claim Page One
Claim Page One
| Field | Description/Valid Values |
|---|---|
| MBI (Required) | Enter the beneficiary’s Medicare Beneficiary Identifier (MBI) |
| TOB (Required) |
Valid Values:
|
| OSCAR (System) | The Medicare provider number (OSCAR number) is system generated. |
| NPI (Required) | Enter the NPI associated with the OSCAR number. |
| STMT DATES FROM (Required) | Enter the date of the hospice transfer in the MMDDYY format. |
| PATIENT DATA (Required) | Enter the beneficiary’s last name, first name, date of birth (MMDDCCYY), full mailing address, ZIP Code and gender. |
| ADMIT DATE (Required) | Enter the date of the hospice transfer in the MMDDYY format. (Note that the ADMIT DATE and the STMT DATES FROM date should match.) |
| OCC CDS/DATE (Required) | Enter the occurrence code 27 along with the date of certification in the MMDDYY format. |
| FAC. ZIP (Required) | Enter the facility ZIP Code of the provider (five- or nine-digit). |
NOC Claim Page Three/Four
Claim Page Three
| Field | Description/Valid Values |
|---|---|
| CD (System) | “Z” is system generated. Do not change. NOCs should be submitted with Medicare as the primary payer. |
| PAYER (System) | “Medicare” is system generated. Do not change. NOCs should be submitted with Medicare as the primary payer. |
| RI (Required) | Enter the release of information indicator. Valid values are:
|
| ATTENDING PHYS NPI/LN/FN (Required) | Enter the NPI and the name of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient’s medical care. |
| OTHER PHYS NPI/LN/FN (Situational) | Enter the NPI and the name of the hospice physician responsible for certifying/recertifying that the patient is terminally ill if the certifying physician differs from the attending physician. Note: For electronic claims using version 5010 or later, this information is reported in Loop ID 2310F - Referring Provider Name. |
Claim Page Four
| Field | Description/Valid Values |
|---|---|
| REMARKS | Enter remarks explaining the transfer including the name, address and provider number (if applicable) of the agency the patient is transferring from along with the effective date of the transfer. |
Submitting the NOC Hard Copy
The following data elements must be completed by the hospice on the Form CMS-1450 for the Notice of Change of Provider if submitting the NOC via hard-copy claim submission.
UB-04
UB-04 (CMS-1450)
| Form Locator (FL) | Description/Valid Values |
|---|---|
| FL 01 | Enter the provider’s name, city, state, and ZIP code |
| FL 04 TYPE OF BILL |
Enter the type of bill for the NOC. Valid values are:
|
| FL 06 STATEMENT COVERS PERIOD- FROM |
Enter the date of the hospice election in the MMDDYY format. |
| FL 08 PATIENT NAME |
Enter the beneficiary’s last name and first name in Line A. |
| FL 09 PATIENT ADDRESS |
Enter the beneficiary’s full mailing address, including street number and name, city, State, and ZIP Code. |
| FL 10 PATIENT BIRTHDATE |
Enter the beneficiary’s date of birth in the MMDDYY format. |
| FL 11 PATIENT SEX |
Enter the beneficiary’s gender. Valid values are:
|
| FL 12 ADMISSION DATE |
Enter the date of the hospice election in the MMDDYY format. (Note that the ADMISSION DATE and the STATEMENT COVERS PERIOD-FROM date should match.) |
| FL 31 OCCURRENCE CODE/DATE |
Enter the occurrence code 27 along with the date of certification in the MMDDYY format. |
| FL 50 PAYER IDENTIFICATION |
Enter “Medicare”. NOCs should be submitted with Medicare as the primary payer. |
| FL 51 HEALTH PLAN ID |
Enter the Medicare provider number (OSCAR number) |
| FL 52 RELEASE OF INFORMATION CERTIFICATION INDICATOR |
Enter the release of information indicator. Valid values are:
|
| FL 56 NPI |
Enter the NPI |
| FL 58 INSURED’S NAME |
Enter the beneficiary’s name as shown on the Health Insurance card or other Medicare notice. |
| FL 60 INSURED’S UNIQUE ID |
Enter the beneficiary’s MBI. |
| FL 76 ATTENDING-NPI/LAST/FIRST |
Enter the NPI and the name of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient’s medical care. |
| FL 78 OTHER-NPI/LAST/FIRST (Situational) |
Enter the NPI and the name of the hospice physician responsible for certifying/recertifying that the patient is terminally ill if the certifying physician differs from the attending physician. |
| FL 80 Remarks |
Enter remarks explaining the transfer including the name, address and provider number (if available) of the agency the patient is transferring from along with the effective date of the transfer. |
Related Content
- Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 25, Completing and Processing the Form CMS-1450 Data Set
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance
Revised 1/13/2023