12/07/2016
Exceptions For Late Hospice Notices of Election Delayed by Medicare Systems
Last week, CMS issued MLN article (SE1633) which announces changes for what scenarios may be eligible for an exception request, when a hospice notice of election (NOE) is submitted timely and cannot be corrected because of existing Medicare system constraints. Beginning with claims submitted on or after November 16, hospices will be able to submit an exception request for inadvertent errors and other errors which are not detected as errors by the Medicare system. CMS has agreed with hospice stakeholders that these errors are outside of the control of hospices, and hence, eligible for exception.
Since the implementation of Change Request (CR) 8877, hospices have been 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 have been 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 2014, 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 were initially instructed to wait for the NOE to be returned to provider (RTP), after which a new NOE could be submitted. In virtually all 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. As a result, hospices have lost significant revenue.
In February 2015, the Centers for Medicare & Medicaid Services (CMS) and the MACs clarified 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 – could immediately submit a corrected NOE rather than having to wait for the RTP to process. The ability to resubmit the NOE 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 HICN
- 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
In cases where an error on a NOE is not detectable by edits in FISS or the CWF - such as an incorrect date of admission - 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 will process through the system.
This week’s notice, MLN Matters Number SE1633: Exceptions for Late Hospice Notices of Election Delayed by Medicare Systems), instructs MACs to grant an exception to the five-day timely filing requirement for late NOEs in cases where the NOE contains an error THAT CANNOT BE CORRECTED WHILE THE NOE IS IN PROCESS. CMS has determined that NOEs that have been submitted timely but that include inadvertent errors that cannot be immediately corrected are the fault of system constraints and therefore are not under the control of the hospice provider. CMS has instructed the MACs to grant an exception to the timely filing requirements in such instances if the hospice is able to provide the MAC documentation showing:
- When the original NOE was submitted
- When the NOE was returned to the hospice for correction or was accepted and available for correction, and
- When the hospice resubmitted the NOE.
CMS indicates that the MACs will grant the exception if all documentation is provided and confirms that the hospice took appropriate actions within 2 business days to make corrections. Once the NOE is returned for correction the hospice will have 2 business days to resubmit. When the NOE was posted to the CWF and must be cancelled and resubmitted, the hospice will have 2 business days to cancel the NOE and then 2 business days to submit the new NOE after the date that the cancellation NOE finalizes.
CMS notes “If the hospice provides sufficient information in the Remarks section of its claim to allow the MAC to research the case, then MACs will make a determination without requesting the additional supporting documentation described above.” The provider’s documentation, however, must provide the circumstances and time frames in order for the MAC to make such a determination, otherwise the MACs will request additional documentation.
CMS stipulates that the exception laid out in SE1633 will NOT be applicable in cases where hospices are able to edit NOEs while they are in process (as referenced above), nor will it be applicable in cases where hospices submit a partial NOE to fulfill the timely-filing requirement. MACs will also not grant exceptions in cases where hospices with multiple provider identifiers submit the identifier of a location that did not actually provide the service.
Finally, CMS indicates that in cases where a NOE is submitted prior to a Medicare system “dark day” but the system does not assign a “receipt date” until the “dark days” have concluded and the hospice can provide sufficient documentation of these circumstances, the MACs may allow for an exception to the timely filing requirement (although CMS expects this will only occur rarely).
CMS is working on additional changes to address issues related to the timely filing requirements; for an update on these efforts, please see here.
