Corporate

January 3, 2019

Untimely NOEs and Hospice Sequential Billing

When all dates of service on a hospice claim are noncovered due to an untimely notice of election (NOE), the claim will reject with the reason code 39929 (claim rejected) and will finalize in the status/location R B9997. Regardless of whether an exception is being requested, it is important to submit the next sequential hospice claim. Medicare regulations require that hospices bill on a monthly basis that conforms to a calendar month. Hospices must also submit claims in date sequence.

When a hospice claim is submitted, the Fiscal Intermediary Standard System (FISS) searches claim history for a prior claim. FISS will locate prior hospice claims located in any of the following status/locations. FISS does not search the RTP file (T B9997) for prior claims.

  • S XXXXX – The status "S" means suspended (e.g., S B6001, S B90XX, S M887)
  • P XXXXX – The status "P" means processed/paid/partial denial (e.g., P B7501, P B9996, P B9997)
  • R XXXXX – The status "R" means rejected (e.g., R B9997, R B75XX)
  • D XXXXX – The status "D" means denied (e.g., D B9997)

When a prior claim is found, but has not yet completed processing, FISS will hold the out of sequence claim until the prior claim has completed processing.

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