December 19, 2017
Correcting Hospice Election and Revocation Dates
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 10064, which allows the submission of Notices of Election (NOEs) to be accepted via Electronic Data Interchange (EDI), effective January 1, 2018. In addition, this CR included updates to the Medicare Claims Processing Manual, Publication 100-04 with billing instructions for correcting an NOE election date, and a revocation date on a Notice of Termination/Revocation (NOTR). Please share the following information with your billing staff.
Correcting NOE Election Date
When a Medicare beneficiary elects hospice services, a timely-filed NOE is submitted. Condition codes are not required on an original NOE. However, if the initial NOE was submitted with an incorrect election date, you may submit a correct NOE with the following billing elements.
- Submit the correct election date in the From and Admission Date fields
- Submit the original election date using occurrence code 56
- Submit condition code D0 (zero).
Note: If the occurrence code 56 and condition code D0 are not submitted together, the NOE will be sent to the Return to Provider file with reason code 34981.
Example: Initial NOE was submitted with the Admit date of 05/17/XX. The actual Admit date is 05/07/XX. To correct the election date, submit a corrected NOE with the following:
Type of Bill | 8XA |
---|---|
Statement Covers Period | Enter 0507XX in the 'FROM' date field |
Statement Covers Period | Enter 0507XX in the 'THROUGH' date field if the NOE is being submitted via EDI. Leave this field blank if the NOE is submitted via Direct Data Entry (DDE). |
Admission Date | Enter 0507XX |
Condition Code | Enter D0 (the number zero) |
Occurrence Code and Date | Enter Occurrence Code 27 and 0507XX (correct Admit date) |
Occurrence Code and Date | Enter Occurrence Code 56 and 0517XX (incorrect Admit date) |
Correcting a Notice of Termination/Revocation (NOTR) Date
If a hospice beneficiary is discharged alive from the hospice or revokes the election of hospice services, a timely-filed NOTR is submitted, unless a final claim has already been submitted. Condition codes are not required on an original NOTR. However, if the initial NOTR was submitted with an incorrect discharge/revocation date, you may submit a correct NOTR with the following billing elements.
- Submit the correct revocation date in the Through Date field
- Submit the original revocation date using occurrence code 56
- Submit condition code D0 (zero).
Note: If the occurrence code 56 and condition code D0 are not submitted together, the NOE will be sent to the Return to Provider file.
Example: Initial NOTR was submitted with the THROUGH date of 05/22/XX. The actual discharge/revocation date is 05/21/XX. To correct the discharge/revocation date, submit a corrected NOTR with the following:
Type of Bill | 8XB |
---|---|
Statement Covers Period | Enter 0501XX in the 'FROM' date field |
Statement Covers Period | Enter 0521XX in the 'THROUGH' date field (correct discharge/revocation date). |
Admission Date | Enter 0501XX |
Condition Code | Enter D0 (the number zero) |
Occurrence Code and Date | Enter Occurrence Code 27 and 0501XX |
Occurrence Code and Date | Enter Occurrence Code 56 and 0522XX (incorrect discharge/revocation date) |
Refer to the following for additional information: