Corporate

Submitting Claims for Untimely Notices of Election (NOEs)

Effective for hospice admissions on/after October 1, 2014, the hospice notice of election (NOE) must be submitted to and accepted by CGS within 5 days after the hospice admission to be considered timely.

To determine the receipt date of the NOE, use the Claim Inquiry option (FISS Option 12) to view the NOE. The 'REC DT' field will indicate the date the NOE was received. In order for the NOE to be timely, the REC DT must be no more than 5 days after the admit date (ADM DT).

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If the NOE is not received timely, those days from admission to the day before the NOE was received, are considered noncovered, and the provider is financially liable for those days.

In addition to the usual hospice claim information, a claim reporting an untimely NOE should include the following on FISS Page 01, FISS Page 02 and FISS Page 04:

FISS Page Field Name Description
01 SPAN CODES/ DATES Enter '77' along with the dates of the noncovered days (date of admission to day before NOE received)
(ex. 77 MMDDYY MMDDYY) Note: If the claim does not include OSC 77 and/or the dates reported with OSC 77 are incorrect, the claim will be returned to the provider (RTPd).
02 REV Enter the level of care revenue code for the noncovered days
02 HCPCS Enter the appropriate HCPCS (Q50XX) for the place of service
02 MODIFS Enter a 'KX' only if you are Requesting an Exception for the untimely NOE.
02 TOT UNIT Enter the total units that were noncovered
02 COV UNIT Leave this field blank
02 TOT CHARGE Enter the total charge for the noncovered days
02 NCOV CHARGE Enter the total charge for the noncovered days
02 SERV DATE Enter the hospice admission date (this will match the "TO" date of the claim)
04 REMARKS Effective with claims received on or after November 16, 2016, that include a 'KX' modifier, providers may clearly indicate all circumstances and time frames that supports the exception request for filing an untimely NOE. CGS will research the case and may grant the exception without requesting additional documentation. If the information in the REMARKS field is not clear, CGS will request documentation by generating a non-medical review additional development request (non-MR ADR). Refer to the Requesting an Exception for an Untimely NOE Web page for more details. Refer to the SE1633 article for additional information.

Example Claim:

Admit Date = 10/10/YY
NOE receipt date (REC DT) = 10/16/YY
Noncovered days = 10/10/YY – 10/15/YY

Example of FISS Page 01

Note: This information is in addition to the usual information required on FISS Page 01

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Example of FISS Page 02

Note: This information is in addition to the usual information required on FISS Page 02.

In this example, 1010YY-1015YY are noncovered. These days are billed as noncovered.

  • The total units for the noncovered days are reported in the TOT UNIT field.
  • No covered units (COV UNIT) are reported.
  • The total charges for the noncovered days are reported in the TOT CHARGE field.
  • The noncovered charges are reported in the NCOV CHARGE field.
  • The SERV DATE on the noncovered line is the date of admission.

The remaining level of care days (1016YY and forward) are billed as usual.

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Important: In addition, all revenue code lines with a SERV DATE that falls between the OSC 77 dates must be reported as noncovered.

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All revenue code lines with a service date (SERV DATE) on/after the NOE was received are reported as usual (reported as covered).

Example of FISS Page 04

If the information in the REMARKS field does not clearly provide all circumstances and time frames, CGS will request documentation via the non-medical review additional development request (non-MR ADR) process. Refer to the Requesting an Exception for an Untimely NOE Web page for details.

Billing Hints:

  • Ensure that the total level of care days reported (noncovered days + covered days) equals that time period reported on the claim.
  • Ensure that the total units (TOT UNIT) for the noncovered days equals the number of days reflected by the dates reported with the OSC 77.
  • If you have submitted your claim with the 'KX' modifier to request an exception, ensure that the REMARKS field on FISS Page 04 clearly indicates all circumstances and time frames supporting your request. If it is not clear, CGS will request additional information. Refer to the 'Requesting an Exception for an Untimely NOE' Web page for additional information.
  • If you submit your claim through a billing service or clearinghouse, there may be limited character space available in the REMARKS field to include all the circumstances and time frames. If no remarks are submitted, or if it is not clear, CGS will generate a non-MR ADR request for documentation supporting your exception request. Providers may also consider entering claims into FISS via Direct Data Entry (DDE) which provides adequate character space.

Updated: 09.28.18

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