NAHC Advocacy Leads CMS to Rethink Electronic Submission of NOE/NOTR
June 6, 2016 01:23 PM
In response to advocacy by the National Association for Home Care & Hospice (NAHC), the Centers for Medicare & Medicaid Services (CMS) is now actively pursuing efforts to allow for use of the institutional claim (837I) to submit hospice Notices of Election (NOEs) and related transactions via Electronic Data Interchange (EDI). This action, in CMS’ words, “would reduce, and potentially eliminate, problems with NOEs that result from errors during the Direct Data Entry (DDE) process.” CMS’ Provider Billing Group is currently in discussions with its National Standards Group (NSG) in the Office of Enterprise Information to explore the potential for allowing hospices to submit NOEs via EDI using a non-standard implementation of the 837I transaction. Once the Provider Billing Group receives an opinion from NSG and has planned its next steps, it will provide a status report to NAHC.
Since October 2014, one of the most administratively burdensome and costly issues that hospices have dealt with has been meeting the timely filing requirements for NOE and Notices of Termination/Revocation (NOTR). Since that time the National Association for Home Care & Hospice (NAHC) and other stakeholders have worked diligently to address the growing number of problems associated with the timely filing policy. Last year NAHC and NHPCO jointly sponsored a hospice survey to help quantify NOE/NOTR-associated costs and financial losses, and the findings of the survey indicated that the financial impact of the requirement has been considerable. Over the last year NAHC has also sought a number of clarifications from CMS and its Medicare Administrative Contractors (MACs) with the goal of easing some of the negative consequences of using direct data entry (DDE) to meet these time-sensitive requirements. While some of these efforts have met with success, each -- on its own -- has made only a relatively modest impact overall, and additional problems continue to emerge in this area.
In implementing the timely filing requirement as part of rulemaking during 2014, CMS stated that NOEs and NOTRs were required to be submitted via DDE as “limitations in electronic submission standards prevent the use of the 837I claim format for this purpose,” but CMS requested input from the hospice industry regarding how electronic submission of NOEs and other transactions might be feasible. Beginning in mid-2015, NAHC began researching the potential for submission of these notices via EDI by exploring the means by which it could initiate development of the electronic submission standards for the NOE/NOTR. However, based on analysis, NAHC soon came to the conclusion that new submission standards may not be necessary since NOE/NOTR are not claims under the Health Insurance Portability and Accountability Act (HIPAA) and therefore should not be subject to the HIPAA transaction submission standards. In a subsequent discussion with CMS Provider Billing Group staff, NAHC discovered that if development of special transaction submission standards for the NOE/NOTR were not necessary, the process for allowing EDI submission of NOE/NOTR would be significantly less complex than had previously been thought by CMS.
Most recently NAHC wrote to Sean Cavanaugh,Director of the Center for Medicare, urging that CMS take action to allow for submission of NOE/NOTR via EDI and providing its analysis of why HIPAA transaction standards are not needed to allow for submission via EDI. In a response from the Center for Medicare’s Provider Billing Group, Director Diane Kovach states,
“Your research into this question and the findings you share in your letter are gratefully received. My claims processing staff reviewed the material [you sent] and believes that our previous understanding on this subject may have been based on incomplete or inaccurate information. You note that the NOE is not a Health Insurance Portability and Accountability Act-covered transaction. It may be feasible for CMS and hospices to develop trading partner agreements to exchange data using a non-standard implementation of the 837I transaction. This would require CMS to develop a companion guide for NOE transition and for hospices to agree to the voluntary adoption of that companion guide.
“In order to assure that any step we take meets all the necessary requirements, I have instructed my staff to review this possible course of action with the National Standards Group (NSG) in CMS’ Office of Enterprise Information. When we receive an opinion from NSG and have considered our next steps, we will communicate the result to you.”
NAHC will provide future updates on this important issue through the NAHC member listserv and in NAHC Report.