CMS Clarifies NOE “Corrections” Policy, MACs Issue Revised Guidance
August 8, 2016 02:30 PM
Since implementation of the timely-filing requirement for hospice Notices of Election (NOE) and Notices of Termination/Revocation (NOTR) in October 2014, numerous problems resulting from the required use of Direct Data Entry (DDE) for submission of NOEs/NOTRs have emerged. The National Association for Home Care & Hospice (NAHC) has provided the Centers for Medicare & Medicaid Services (CMS) analysis that may pave the way for CMS to allow for electronic submission of NOEs and related transactions. In the interim, NAHC, CMS, the Medicare Administrative Contractors (MACs) and others are working to modify existing policies that are resulting in increased costs and lost revenue to hospice providers. CMS has recently issued a clarification to the MACs that will help in this regard.
As part of instructions related to timely submission of NOEs, the MACs have historically told hospice providers that if information (such as the principal diagnosis or physician) is entered on a NOE and that information later changes, the hospice need not “correct” the diagnosis code by cancelling and resubmitting the NOE. Instead, the hospice may just enter the newly-established principal diagnosis on the subsequent claim. However, if the information entered on the NOE is incorrect at the time it is entered, the MACs previously instructed hospice providers to cancel the NOE and resubmit with the correct information. Cancellation of the NOE and resubmission will very likely result in late acceptance of the NOE, which means that the hospice will sustain some financial losses for early days of care. As an example, following is a previously posted instruction from one of the HHH MAC websites relative to NOE submission:
Question: If an NOE was submitted timely, but information on the NOE is determined to be incorrect (physician name, diagnosis code, etc.) what action should be taken and will the NOE that was filed initially meet the timely filing requirement?
Answer: If the information has simply changed (certifying physician changed or diagnosis code changed), you do not need to cancel the NOE.
If, however, the information on the processed NOE is truly incorrect (wrong doctor, wrong diagnosis code, etc.), the NOE should be canceled (type of bill 8XD). Once the NOE has been canceled, submit a new NOE with the correct information. Canceling and resubmitting the NOE will result in an untimely NOE. In this case, keep documentation of the action you took and why. If you choose to request an exception by submitting HCPCS modifier 'KX', the documentation can be submitted for consideration when determining whether it meets the CMS indicated exceptions. Note that for an exception to be granted, the documentation must show that the late filing of the NOE was beyond the control of the hospice. Billing errors are not considered a valid exception request.
Very recently, CMS conducted outreach to the HHH MACs to clarify that, in cases where NOEs have been submitted with incorrect principal diagnosis codes or physician names, it is not necessary for the hospice to cancel the NOE and resubmit it; rather, the hospice may wait for the subsequent claim to provide the proper principal diagnosis or physician name. CMS does stress that it expects that information provided on the NOE is free of transcribing errors, and strongly encourages hospices to initiate quality assurance measures regarding the accuracy of the NOE information to mitigate any potential untimely NOEs.
Following is current information excerpted from the HHH MAC websites related to the recent clarification:
National Government Services (NGS):
Correcting Diagnosis Codes
If an incorrect diagnosis code is mistakenly entered on the NOE and accepted by the system, providers do NOT need to/should NOT cancel and submit a new NOE. A corrected diagnosis would need to be put on the claim.
Correcting Attending Physician
If an incorrect attending physician NPI is entered on the NOE, the NOE does NOT need to/should NOT be cancelled and resubmitted. The correct attending physician NPI will need to be put on the claim.
Update to FAQ on Timely Filing of Notices of Election: CGS has updated a frequently asked question (FAQ) after receiving clarification about situations where an incorrect physician name, and or diagnosis code is submitted on the notice of election (NOE). If the information has simply changed or a keying error occurred, the NOE does not need to be canceled and resubmitted. Instead, corrections to diagnosis codes and certifying physicians on the NOE may be made on subsequent claims. To view the updated FAQ, access the “Change Request 8877 Frequently Asked Questions” Web Page and select FAQ #7 under the “Timely Filing of Notices of Election (NOE)” heading.
Question: What process should be followed when a NOE has to be changed after it is initially filed? For instance, this can happen when the attending physician or principle hospice diagnosis changes soon after admission. Will the initial filing of the NOE be "retained" in the system so that when a revised NOE is filed the five-day edit won't be a problem or would any corrections just be made on the first claim?
Answer: If the information has simply changed or a keying error occurred on the certifying physician or diagnosis code, you do not need to cancel the NOE. Corrections to diagnosis codes and certifying physicians on the NOE may be made on subsequent claims. Since there is no editing in Medicare systems that ensures the diagnosis codes and certifying physicians on hospice claims match the NOE, hospices can correct diagnosis coding and certifying physicians errors on subsequent claims, without canceling the NOE.
Hospices are reminded that in cases where a hospice has recently submitted an NOE that they discover has an error that will result in a return to provider (RTP) when it hits edits in CMS’ systems (for example with incorrect beneficiary information), the hospice need not wait for the NOE to RTP to submit a corrected NOE. Taking this action on a timely basis may in some instances help a hospice avoid loss of payment for the first few days of care due to late “receipt” of the NOE.