Corporate

November 6, 2018

Reminder: When to Submit Occurrence Code 27 on Hospice Claims

Hospices must report occurrence code (OC) 27 and the date on all notices of election (NOEs) and initial claims following a hospice election and on all subsequent claims when the claim’s dates of service overlap the first day of the next benefit period.  When OC 27 is required, but not reported, or does not include the correct date, the NOE or claim will receive reason code U5181 and will be returned to the provider (RTP) for correction.

Notices of Election

The OC 27 and the date of certification must be reported.  This date must match the FROM date and ADMIT DATE.

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Initial Claim

OC 27 is reported on the claim for the billing period in which the certification or recertification was obtained. The OC 27 date must match the FROM date and the ADMIT DATE.

When a patient is transferred from one hospice to another, if the transfer takes place during the first certification period, the receiving hospice would use the same certification date as the previous hospice until the next certification period. If the transfer takes place in the next certification, the hospice would enter the first date of that certification as the OC 27 date.

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Subsequent Claims (timely recertification)

OC 27 is reported on subsequent claims when the dates of service overlap the first day of the next benefit period. The OC 27 date reported is the first day of the new benefit period.

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Subsequent Claims (untimely recertification)

When the recertification is not obtained timely (by the end of the third calendar day) the occurrence span code (OSC) 77 should be reported. Because OC 27 reflects the date the recertification was actually obtained, the OC 27 date cannot fall within the OSC 77 dates.  If the recertification was not obtained within the FROM and TO dates, OC 27 is not required.

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References

Please refer to the following for additional information and resources:

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