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June 9, 2022

Reminders About Exception Requests

Due to the improper use of modifier KX and the Additional Documentation Request (ADR) process, please review the following reminders about exception requests to avoid claim processing delays/errors.

Home Health Notices of Admission (NOAs) and Hospice Notices of Election (NOEs) must be submitted within five calendar days after the admission date. If an NOA/NOE is not filed timely, you may request an exception, which, if approved, waives the consequences of late filing.

When to Request an Exception

The four circumstances that may qualify for an exception are:

  • Fires, floods, earthquakes or other unusual events that inflict extensive damage to the provider's ability to operate
  • An event that produces a data filing problem due to a CMS or MAC system issue that is beyond the provider's control
  • A newly Medicare-certified provider that is notified of their certification after the Medicare certification date or is awaiting its user ID from the MAC
  • Other circumstances determined by the MAC or CMS to be beyond the provider's control

How to Request an Exception

If an NOA/NOE is untimely due to one of the circumstances above, report the following information on the associated claim for payment (i.e., TOB 329 (home health) or TOB 8X1, 8X2, 8X3 or 8X4 (hospice)):

  • Modifier KX (indicates you are requesting an exception for the untimely NOA/NOE)
  • REMARKS field (FISS Page 04) – Clearly indicate all the circumstances and time frames that support the exception request.

Non-Medical Review Additional Documentation Requests (Non-MR ADRs)

If the information in the REMARKS field is missing or insufficient, the claim will suspend to FISS status/location S B6001 with reason code 39701 and a non-MR ADR will generate. Check for ADRs on a regular basis, read the ADR in its entirety, and follow the instructions in the ADR to submit your documentation no later than 30 calendar days from the date of the request.

Resources

Detailed information can also be found in the following resources:

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