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Hospice Claims Filing

The Medicare hospice benefit requires providers to submit a Notice of Election (NOE) and a claim. In some situations, a notice of a change of a hospice provider, or a Notice of Election Termination/Revocation (NOTR) also needs to be submitted. The following information provides guidance on how to enter these billing transactions in the Fiscal Intermediary Standard System (FISS) Claims/Attachments option (FISS Main Menu option 02) via Direct Data Entry (DDE). For more detailed information about FISS, refer to the Chapters 1-5 of the FISS Guide.

Notice of Election

The NOE 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. Hospices must submit the NOE within 5 calendar days after the hospice admission (refer to the Change Request 8877 CGS Web page for additional information). 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 in FISS via DDE, or via a paper UB-04; they cannot be submitted electronically.

Notice of Elections (NOEs)/Transfer NOE

If the NOE is submitted untimely, refer to the following resources:

Hospice Claims

Hospices claims must be billed 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). Review the Hospice Sequential Billing Web page for additional information.

Hospice Claims

Notice of Election Termination/Revocation (NOTR) – 8XB

Hospices are 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 additional information, refer to the Change Request 8877 CGS Web page.

Notice of Election Termination/Revocation (NOTR) – 8XB

Special Hospice Claims Filing Situations

Additional Resources

Medicare Billing: 837I and Form CMS-1450External PDF

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)External PDF

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)External Website

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.

Updated: 03.30.17

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