Corporate

Transferring Beneficiary From/To Another Hospice Agency

Once in each benefit period, a hospice beneficiary may change the designation of the hospice he/she wishes to receive care from. You can check to see if the beneficiary has already transferred once within the current benefit period by:

  • Asking the beneficiary if they have received hospice care from another hospice agency, and when;
  • Asking the hospice agency that the beneficiary is transferring from when they admitted the patient and if they received the patient on transfer from another hospice;
  • Review ELGH Page 19 to determine if the provider number of the hospice the patient is transferring from appears in the PROVIDER NO field. If so, this indicates the patient has not transferred previously in this benefit period. (See sample screenprint below.)

    Screenshot

Note: To look up the name and address of the hospice agency that appears in the PROVIDER NO field on ELGH Page 19, go to http://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/Hospice.htmlExternal Website. Click on the link 'Hospice Reports' and open the Excel file titled "HOSPC_PRVDR_ID_INFO".

When a hospice patient transfers to another hospice agency, the beneficiary must file a signed statement with the transferring hospice (Hospice #1) and the receiving hospice (Hospice #2). The statement must include the name of the prior hospice, the name of the 'new' hospice, and the date the transfer is effective.

In addition, the Hospice Conditions of Participation, 42 Part 418 §418.104External Website, state that "if the care of a patient is transferred to another Medicare/Medicaid-certified facility, the hospice must forward to the receiving facility, a copy of the hospice discharge summary, and the patient's clinical record, if requested".

The table below provides billing instructions for hospices when a patient is transferring either to or from your agency.

Patient Transferring FROM Your Agency Patient Transferring TO Your Agency

Submit your final claim promptly to allow the agency receiving the transferring beneficiary to submit their Notice of Change (NOC). Both the transferring and receiving hospice agencies may bill for the day of transfer.

In addition to the usual claim information, report the following on your final claim indicating the transfer:

  • Type of Bill (TOB) =
    • 8X1 - if this is the only claim you are submitting for the patient; or
    • 8X4 - if you have previously submitted a hospice claim for this patient
  • Patient Status (STAT) =
    • 50 - if the patient is transferring under routine or continuous home care
    • 51 – if the beneficiary is transferring under respite or general inpatient care
  • Remarks = Enter the name, address and provider number of the receiving hospice agency.

Note: Do not use occurrence code 42 on a hospice claim when the patient is transferring to another hospice.

Submit a Notice of Change (NOC), prior to submitting your first claim. This indicates that the admission is a continuation of the current benefit period. The NOC must be submitted after the transferring hospice agency has submitted their final claim.

To submit the NOC, enter the same information as you would for a notice of election, except for the following:

  • Type of Bill (TOB) = 81C or 82C
  • From date (STMT FROM DATE) = the date your agency started hospice care
  • Admission date (ADMIT DATE) = the date your agency admitted the transferring beneficiary
  • Remarks = Enter the name, address and provider number of the hospice agency the patient transferred from

NOTE: The NOC (81C or 82C) must process before your agency may submit your first claim.

When you bill your first claim, an occurrence code 27 must be reported. The date used with OC 27 is based on which benefit period the claim falls within or overlaps.

  • If your claim does not overlap the start date of a new benefit period, enter the START DATE of the current benefit period (as shown on ELGH/ELGA). This date will be prior to your 'From' and 'Admit' date; or
  • If your claim overlaps the TERM DATE of the current benefit period (on ELGA/ELGH), enter the START DATE of the next benefit period.

Reference: Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9§20.2

Updated: 12.19.18

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