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 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 Election
The NOE is submitted after the beneficiary has signed the election statement and is only submitted once. Effective for dates of service on/after October 1, 2014, per Change Request 8877, hospices must submit the NOE within 5 calendar days after the hospice admission. To be timely, the NOE must be submitted to, and accepted by, CGS. To be accepted by CGS, the NOE must be free of billing or keying errors that would cause the NOE to be returned or rejected. 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. For additional information, refer to the Change Request 8877 CGS Web page.
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 Web page.
Change Request 8358requires additional data reporting on hospice claims. Hospice may begin reporting the additional data for dates of service January 1, 2014. Additional data reporting will be required on claims with dates of service April 1, 2014. For additional information, refer to "Claim Page 02 – Entering a Hospice Claim" Web page.
In addition, effective for dates of service on/after October 1, 2014, per Change Request 8877, hospices are also required to submit a Notice of Termination/Revocation (NOTR), also known as a type of bill (TOB) 8XB, within 5 calendar days after a hospice discharge/revocation, unless a final claim has already been submitted. For information on submitting a NOTR, see "Notice of Termination/Revocation (NOTR) - 8XB" below. For additional information, refer to the Change Request 8877 CGS Web page.
Notice of Elections (NOEs)/Transfer NOE
Notice of Election Termination/Revocation (NOTR) – 8XB
Special Hospice Claims Filing Situations
- Medicare Billing: 837I and Form CMS-1450
This CMS fact sheet offers an overview of the 837I and CMS-1450 (UB-04), which is used by institutional providers to submit claims electronically or when a paper claim is allowed, and may be suitable for billing various government and some private insurers.
- Timely Filing Requirements
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)
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)
Refer to the NUBC website for a complete description of all the items included on the CMS-1450 (UB-04) claim form.
- Hospice Quick Resource Tools
A variety of tools developed by the CGS Provider Outreach and Education staff are available to assist in the successful processing of your claims.