Hospice Claims Filing
The Medicare hospice benefit requires that providers submit two types of billing transactions: the Notice of Election (NOE) and the claim. The NOE (an abbreviated claim) is submitted to notify the Medicare contractor, and the Common Working File (CWF), of the start date of the beneficiary's election to the hospice benefit. The NOE is submitted after the beneficiary has signed the election statement and is only submitted once. NOEs can only be submitted direct data entry (DDE) using the Fiscal Intermediary Standard System (FISS), or via a paper UB-04; they cannot be submitted electronically.
Hospices are required to bill claims sequentially. The first hospice claim for a beneficiary may be submitted only after the NOE has processed (P B9997). After the first claim processes (pays, denies or rejects), the subsequent claim can then be submitted. Due to sequential billing, hospice claims must be submitted monthly and processed in date order. In addition, only one claim is allowed per month, per beneficiary (except when the patient has been discharged/revoked, and re-elected hospice care).
Before billing your first claim to Medicare, review the Hospice Sequential Billing webpage.
The Fiscal Intermediary Standard System (FISS) Claims/Attachments option (FISS Main Menu option 02) allows you to enter NOEs and hospice claims. The following provides screen prints and field descriptions for each of the six FISS claim pages and identifies which page/fields are required for NOEs and hospice claims. For more detailed information about FISS, refer to the Chapters 1-5 of the FISS Guide.
Notice of Elections (NOEs)/Transfer NOE
Hospice Claims
Special Hospice Claims Filing Situations
- Billing Hospice Physician and Nurse Practitioner (NP) Services
- Canceling a Notice of Election or Benefit Period
- Change of Ownership
- Discharge or Revocation of Hospice Care
- Hospice Expedited Determination Process
- Hospice Sequential Billing Requirements
- Influenza Vaccines and Hospice
- Occurrence Code 42 Omitted
- Requests for Medical Denials
- Transferring Beneficiary From/To Another Hospice Agency
- Untimely Face-To-Face Encounter
- Untimely Recertifications and Occurrence Span Code (OSC) 77
Additional Resources
- UB-04 Overview Fact Sheet
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This CMS fact sheet offers an overview of the UB-04, also known as the Form-1450, which is the uniform institutional provider hardcopy claim form suitable for use in billing multiple third party payers.
- Timely Filing Requirements
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Section 6404 of the Patient Protection and Affordable Care Act (PPACA) amended the timely filing requirements to reduce the maximum time period for submission of all Medicare claims, including adjustments and cancels, to one calendar year after the date of service.
- Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 11)
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Chapter 11 of the Medicare Claims Processing Manual provides information about the Medicare hospice benefit including billing and payment of hospice and physician services, and the hospice cap and limitations.
- National Uniform Billing Committee (NUBC)
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Refer to the NUBC web site for a complete description of all the items included on the CMS-1450 (UB-04) claim form.
- Hospice Quick Resource Tools
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A variety of tools developed by the CGS Provider Outreach and Education staff are available to assist in the successful processing of your claims.
Updated: 06.06.13
