Top Claim Submission Errors for Hospice Providers: Error U5194
Reason for error: The hospice notice of election (NOE) must be received within 5 calendar days after the effective date of the hospice election. When the NOE is not received timely, Medicare will not cover/pay for days of care from the admission date to the date the NOE was submitted/accepted. Occurrence span code (OSC) 77 must be reported to identify the dates from the date of admission to the date before the NOE was received. If the OSC 77 is missing or the dates are incorrect, the claim will receive this reason code.
Claim processing result: Return to Provider (RTP)
How to prevent/resolve:
- Use FISS Option 12 to determine the date CGS received the NOE.
Example of timely/untimely NOE calculation:
- Admission date = 10/10/YY
- Day 1 = 10/11/YY
- Day 2 = 10/12/YY
- Day 3 = 10/13/YY
- Day 4 = 10/14/YY
- Day 5 = 10/15/YY (This is the NOE "due date")
If the NOE is received and accepted on/after 10/16/YY, it is untimely.
The following is an example of an untimely NOE and shows the admission date of 10/10/YY with a receipt date of 10/16/YY.
- When an NOE is untimely, the noncovered days from the admission date to the day before the NOE was received must be reported on the claim with the occurrence span code 77.
NOTE: When the NOE is untimely, the revenue code lines/charges for the noncovered level of care days, (OSC 77), must be submitted as noncovered on FISS Page 02.
Resources:
- MLN Matters® Article MM8877
, "Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election (NOE) and Termination or Revocation of Election." - Change Request 8877 Frequently Asked Questions
- Submitting Claims for Untimely Notices of Election (NOEs)
Updated: 11.01.18
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