CMS Allows for Resubmission of Some Hospice NOE/NOTRs to Correct Billing Errors
February 5, 2015 10:35 AM
Effective with the implementation of Change Request (CR) 8877, hospices are now required to submit a Notice of Election (NOE) for hospice patients admitted on or after October 1, 2014 within five days following the date of admission. In instances where a hospice fails to file the NOE on a timely basis, payment will be denied for days of service prior to the Medicare Administrative Contractor’s (MAC’s) receipt and acceptance of the NOE. Hospices are also required to submit a Notice of Termination/Revocation (NOTR) within five days following the date of live discharge, as well, but no penalty for late submission is being assessed at this time.
Since October, many hospices have failed to meet the NOE timely filing requirement because they have submitted NOEs that include errors. To correct NOE billing errors, hospices have been required to wait for the NOE to be returned to provider (RTP), after which a new NOE could be submitted. In many cases, the systems time required to process the RTP has meant that a replacement NOE could not be submitted and accepted in time for the hospice to be in compliance with the five-day rule.
In welcome news, two of the Centers for Medicare & Medicaid Services (CMS)’ MACs have reported that hospices that discover they have submitted an NOE with a systems-detectable billing error that will cause the NOE to RTP - such as an incorrect HICN - may now immediately submit a corrected NOE rather than having to wait for the RTP to process.
The National Association for Home Care & Hospice (NAHC) has confirmed with CMS that this change is now in effect. CMS has also indicated that hospices may immediately resubmit corrected NOTRs, as well, where submitted NOTRs included errors that would otherwise cause the NOTR to RTP. This change will help to reduce the likelihood that systems processing time will result in lost revenue to hospices as the result of the NOE requirement.
Hospices must note that the ability to resubmit an NOW or NOTR that contains an error is contingent on the error being one that the system can detect and that would result in an RTP if the NOE or NOTR is left to process through the system. These errors are ones that the FISS or CWF system edits would detect as part of systems cross-checking.
Following are just a few examples of some common NOE and/or NOTR billing errors that could cause the submission to RTP:
Invalid marital status
Invalid/missing FROM date
Invalid/missing payer code
Occurrence code 27 required on NOEs
Invalid NPI – hospice agency or attending/certifying physician
Invalid type of bill – inconsistent with provider number
Beneficiary’s name/HIC don’t match
NOE falls within established hospice benefit periods
Hospices must also note that in cases where an error on a NOE/NOTR is not detectable by edits in FISS or the CWF - such as an incorrect date of discharge on an NOTR - immediate resubmission will not work because the systems have no way to know whether the information that has been changed was incorrect. In such cases the original NOE/NOTR will process through the system.
Following are links to information posted by CGS and National Government Services (NGS), two of the Home Health/Hospice MACs, on the issue. As of this writing Palmetto GBA had not yet made any information on this issue public:
NAHC anticipates that the Home Health and Hospice MACs will be issuing additional information on this change and will be conducting education to assist providers in gaining greater understanding of this change. NAHC will continue to report on this and related matters as additional information emerges.
Watch the NAHC Member Listserv and NAHC Report for future updates.