(Medicare Claims Processing Manual)

The reporting requirement, optional for notice of elections effective on or after January 1, 2010, and required reporting on or after April 1, 2010, establishes that the hospice enters the NPI and name of the attending physician designated by the patient a t the time of election as having the most significant role in the determination and delivery of the patients medical care.   Other Physician I.D .  The hospice enters the NPI and name of the hospice physician responsible for certifying that the patient is terminally ill, with a life expectancy of 6 months or less if the disease runs its normal course. Note: Both the attending physician and other physi cian fields should be completed unless the patients designated attending physician is the same as the physician certifying the terminal illness. When the attending physician is also the physician certifying the terminal illness, only the attending physician is required to be reported.  Provider Representative Signature and Date  A hospice representative must make sure the required physicians certification, and a signed hospice election statement are in the records before signing the Form CMS -1450. A stamped signature is acceptable.   20.1.2 - Notice of Termination/Revocation (NOTR)                                                                       (Rev. 12083; Issued: 06- 15-23; Effective: 05 -15-23; Implementation: 07- 17-23)  NOTR is used when the hospice beneficiary is discharged alive from the hospice or revokes the election of hospice services. An NOTR should not be used when a patient is transferred.  If a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, the hospice shall file a timely -filed Notice of Election Termination / Revocation (NOTR), unless it has already filed a final claim. A timely -filed NOTR is a NOTR that is submitted to the A/B MAC (HHH) and accepted by the A/B MAC (HHH) within 5 calendar days after the effective date of discharge or revocation. While a timely -filed NOTR is one that is submitted to and accepted by the A/B MAC (HHH) within 5 calendar days after the hospice election, posting to the CWF may not occur within that same timeframe. The date of posting to the CWF is not a reflection of whether the NOTR is considered timely -filed.  In order for the NOTR to be accepted into the system, an election period must be established. If the notice of election, which creates the hospice election period is not submitted and posted before the NOTR, the NOTR will be rejected.  Type of Bill  Enter the appropriate 3 -digit numeric type of bill code, according to the following code structure:  81B- Hospice (Nonhospital -Based) NOTR  82B- Hospice (hospital -Based) NOTR  Statement Covers Period (From -Through)   The hospice submits the From date on an NOTR differently in the following scenarios: When there is no change in the provider number during the election, the hospice must submit the start date of the election period as the From date on the NOTR.   If the revocation follows a transfer, the From date on the NOTR must match the START DATE2 on the benefit period that initiated the transfer.   If the revocation follows a change of ownership, the From date on the NOTR must match the OWNER CHANGE start date on the benefit periods. This process is to ensure that only the provider currently providing services to the beneficiary can submit the NOTR.  In all cases, the Admission Date on the NOTR must match the From date.  Patients Name  The patients name is shown with the surname first, first name, and middle initial, if any.  Patients Address  The patients full mailing address including street name and number, post office box number or RFD, city, State, and ZIP code.  Patients Birth Date  Show the month, day, and year of birth numerically as MM -DD-YYYY.  Patients Sex  Show an M for male or an F for female. This item is used in conjunction with diagnoses and surgical procedures to identify inconsistencies.  Admission Date  The hospice enters the admission date, which must be the start date of the benefit period in all cases except when a transfer occurs.  On a NOTR, the hospice enters the start date of the hospice benefit period in which the discharge or revocation is effective, not the initial hospice admission date.  Show the month, day, and year numerically as MM -DD-YY.  Facility Zip Code  Enter the hospice's ZIP code (9- digit). The ZIP code entered must match the ZIP code in the Master Address field of the provider's address file.  Condition Codes  Condition codes are not required on an original NOTR. If the hospice is correcting a revocation date using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the NOTR will be returned to the hospice.  Occurrence Codes and Dates  Hospices may submit an NOTR that corrects a revocation date previously submitted in error. In this case, the hospice reports the correct revocation date in the Through Date field and reports the original, incorrect revocation date using occurrence code 56. Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that revocation date with the corrected information.  If a revocation date was submitted entirely in error (for instance, the beneficiary actually transferred to another hospice, rather than revoking their hospice benefit), the hospice can remove the revocation date via Direct Data Entry by submitting TOB 8xB  with zeroes in the Through date. The hospice reports the original, incorrect revocation date on the NOTR using occurrence code 56 and indicate the NOTR is a correction by adding condition code D0.  Release of Information  Valid values are:  I- Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes  Y -Yes, provider has a signed statement permitting release of information.    Provider Number  The hospice enters their NPI. Medicare systems ensure that the provider number submitted on the NOTR is the currently active billing provider (e.g. the provider number matches that on the hospice election period or the most recent transfer date or change o f ownership date on any benefit period). If any other provider number is submitted, the NOTR is returned.  Insureds Name  Send all NOEs with Medicare as the primary payer. Enter the beneficiarys name on line A. Show the name exactly as it appears on the beneficiarys HI card.  Insureds Unique Identifier  On the same lettered line (A, B, or C) that corresponds to the line on which Medicare payer information is shown enter the patients unique identifier by the health plan for the insured. For example, if Medicare is the primary payer, enter the MBI . To ensure accuracy and prevent a delay in the timely receipt or  posting the hospice notice of election, hospices should validate this information using the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS). Only in the event that  the HETS data is not available should the hospice show the number as it appears on the patients HI Card, Social Security Award Certificate, Utilization Notice, EOMB, Temporary Eligibility Notice, etc., or as reported by the SSO.   Principal Diagnosis Code  CMS accepts only HIPAA approved ICD-9- CM or ICD -10-CM/ICD -10-PCS codes, depending on the date of service. The official ICD-9-CM codes, which were updated annually through October 1, 2013, are posted at http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html   The official annual updates to ICD-10-CM and ICD-10- PCS codes are posted at http://www.cms.gov/Medicare/Coding/ICD10/index.html    Use full diagnosis codes including all applicable digits, up to five digits for ICD-9- CM and up to seven digits for ICD-10-CM.  Attending Physician I.D .  For notice of elections effective prior to January 1, 2010, the hospice enters the National Provider Identifier (NPI) and name of the physician currently responsible for certifying the terminal illness, and signing the individuals plan of care for medical  care and treatment.  The reporting requirement, optional for notice of elections effective on or after January 1, 2010, and required reporting on or after April 1, 2010, establishes that the hospice enters the NPI and name of the attending physician designated by the patient a t the time of election as having the most significant role in the determination and delivery of the patients medical care.  Other Physician I.D .  The hospice enters the NPI and name of the hospice physician responsible for certifying that the patient is terminally ill, with a life expectancy of 6 months or less if the disease runs its normal course. Note: Both the attending physician and other physi cian fields should be completed unless the patients designated attending physician is the same as the physician certifying the terminal illness. When the attending physician is also the physician certifying the terminal illness, only the attending physici an is required to be reported.  NOTE: for electronic claims using version 5010 or later, this information is reported in Loop ID 2310F  Referring Provider Name.  Provider Representative Signature and Date  A hospice representative must make sure the required physicians certification, and a signed hospice election statement are in the records before signing the Form CMS -1450. A stamped signature is acceptable.  20.1.3 - Change of Provider/Transfer Notice                                                                        (Rev. 12083; Issued: 06- 15-23; Effective: 05 -15-23; Implementation: 07- 17-23)  If the beneficiary is transferred to another hospice  (discharge status codes 50 or 51) the claim does not terminate the beneficiarys current hospice benefit period. The admitting hospice submits a transfer notice after the transfer has occurred and the beneficiarys hospice benefit is not affected. The 8XC does not get submitted until after the other provider has finalized their billing.   NOTE:  Transfers are not allowed from the same provider. Hospices must not submit an 8XC if the CMS Certification Number (CCN) is the same. In this scenario the beneficiary is not transferred to another hospice, they are transferred to another location of the sa me hospice.   A beneficiary can change hospices only once per benefit period (90 -day or 60- day). When the beneficiary transfers to a different hospice, he/she continues in the same benefit period.  To transfer hospice programs, the individual or representative must file, with the hospice from which care has been received and with the newly designated hospice, a statement that includes the following information:  (1) The name of the hospice from which the individual has received care and the name of the hospice from which he or she plans to receive care.  (2) The date the change is to be effective.  Given that hospices bill for the date of discharge or transfer, for claims purposes, the From date for the receiving hospice must be the same as the Through date for the transferring hospice, otherwise this would constitute a gap in care and a gap in billing and would not be considered a transfer. For example, if a beneficiary designates that a transfer is to be effective on January 10th, the transferring hospices Through date must be January 10th and the receiving hospices From date must be Janua ry 10th in order to be a continuous hospice election without a gap in care or billing. That is, the transferring hospice is responsible for the beneficiary up until, and including the transfer date.   If the beneficiary is transferring from outside the service area and the transferring hospice cannot arrange care until the beneficiary reaches the new hospice, the hospice may discharge the beneficiary. This way, if the beneficiary requires medical treat ment while in the process of transferring, he/she can access it under his/her traditional Medicare coverage. This would terminate the beneficiarys current benefit period and require the beneficiary to re- elect hospice coverage at the new hospice and begin  a new benefit period.  The hospice transfer will be rejected if the transfer does not occur immediately. If the receiving hospices claim from date is not the same as the through date with "patient status indicating a transfer (codes 50 or 51), the transfer will be rejected . The edit will not apply to a subsequent claim, if a transfer is posted and the hospices claim from date is the same as the transfer date.  Type of Bill   Enter the appropriate 3 -digit numeric type of bill code, according to the following code structure:   81C -  Hospice (Nonhospital -Based) Change of provider  82C -  Hospice (Hospital -Based) Change of provider   Statement Covers Period (From -Through)   The From date would be the date the change is effective. No through date is required.   Patients Name   The patients name is shown with the surname first, first name, and middle initial, if any.  Patients Address   The patients full mailing address including street name and number, post office box number or RFD, city, State, and ZIP code.   Patients Birth Date