(Medicare Claims Processing Manual)

Reason 2:  In the case of a discharge when the hospice determines the beneficiary is no longer terminally ill, the hospice uses the NUBC approved discharge status code that best describes the beneficiarys situation.  The hospice does not report occurrence  code 42 on their claim.  This discharge claim will terminate the beneficiarys current hospice benefit period as of the "Through date on the claim.  Reason 3:  In the case of a discharge for cause, the hospice uses the NUBC approved discharge status code that best describes the beneficiarys situation.  The hospice does not report occurrence code 42 on their claim.  Instead, the hospice reports conditi on code H2 to indicate a discharge for cause.  The effect of this discharge claim on the beneficiarys current hospice benefit period depends on the discharge status.   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 of Election (type of bill 8xC) after the transfer has occurred and the beneficiarys hospice benefit is not affected.  If any other appropriate discharge status code is used, this discharge claim will terminate the beneficiarys current hospice benefit period as of the Through date on the claim .  The beneficiary may re-elect the hospice benefit if they are certified as terminally ill and eligible for the benefit again in the future and are willing to be compliant with care.   If the beneficiary has chosen to revoke their hospice election, the provider uses the NUBC approved discharge patient status code and the occurrence code 42 indicating the date the beneficiary revoked the benefit.  The beneficiary may re -elect the hospice benefit if they are certified as terminally ill and eligible for the benefit again in the future.   Discharge Reason  Coding Required in Addition to Patient Status Code  Beneficiary Moves Out of Service Area  Condition Code 52  Beneficiary Transfers Hospices  Patient Status Code 50 or 51; no other indicator  Beneficiary No Longer Terminally Ill  No other indicator  Beneficiary Discharged for Cause  Condition code H2  Beneficiary Revokes  Occurrence code  42  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) using type of bill 8xB, 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 accept ed 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.  A NOTR (type of bil l 8xB) is entered via Direct Data Entry in the same way as an NOE (type of bill 8xA).  Hospices continue to have 12 months from the date of service in which to file their claims timely.   A patient can also be admitted and discharged on the same day.  They would submit an 8x1 Type of Bill (Admission through Discharge Claim), matching From and Through dates, and whatever the appropriate level of care the revenue code was, with 1 unit. A patient cannot be discharged and re- admitted to the same hospice on the same day.  Untimely Face -to-Face Encounters and Discharge   When a required face- to-face encounter occurs prior to, but no more than 30 calendar days prior to, the third benefit period recertification and  every benefit period recertification thereafter , it is considered timely.  A timely face -to-face encounter would be evident when examining the face- to-face attestation, which is part of the recertification, as that attestation includes the date of the encounter. While the face- to-face encounter itself must occur no more than 30 calendar days prior to the start of t he third benefit period recertification and each subsequent recertification, its accompanying attestation must be completed before the claim is submitted.   If the required face -to-face encounter is not timely, the hospice would be unable to recertify the patient as being terminally ill, and the patient would cease to be eligible for the Medicare hospice benefit.  In such instances, the hospice must discharge the patient from the Medicare hospice benefit because he or she is not considered terminally ill for Medicare purposes.   When a discharge from the Medicare hospice benefit occurs due to failure to perform a required face- to-face encounter timely, the claim should include the most appropriate patient discharge status code.  Occurrence span code 77 does not apply when the face -to-face encounter has not occurred timely.   The hospice can re -admit the patient to the Medicare hospice benefit once the required encounter occurs, provided the patient continues to meet all of the eligibility requirements and the patient (or representative) files an election statement in accordanc e with CMS regulations.  Where the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospices failure to meet the face- to-face requirement, CMS would expect the hospice to continue to care for the patient at its own expense until the required encounter occurs, enabling the hospice to re -establish Medicare eligibility.   Condition Codes   The hospice enters any appropriate NUBC approved code(s) identifying conditions related to this bill that may affect processing.  Codes listed below are only those most frequently applicable to hospice claims.  For a complete list of codes, see the NUBC manual.   07 Treatment of Non -terminal Condition for Hospice  Code indicates the patient has elected hospice care but the provider is not treating the terminal condition, and is, therefore, requesting regular Medicare payment.  20 Beneficiary Requested Billing  Code indicates the provider realizes the services on this bill are at a noncovered level of care or otherwise excluded from coverage, but the beneficiary has requested a formal determination.  21 Billing for Denial Notice  Code indicates the provider realizes services are at a noncovered level of care or excluded, but requests a denial notice from Medicare in order to bill Medicaid or other insurers.  H2 Discharge by a Hospice Provider for Cause  Discharge by a Hospice Provider for Cause.   NOTE :  Used by the provider to indicate the patient meets the hospices documented policy addressing discharges for cause.  52 Out of Hospice Service Area  Code indicates the patient is discharged for moving out of the hospice service area.  This can include patients who relocate or who go on vacation outside of the hospices service area, or patients who are admitted to a hospital or SNF that does not have contractual arrangements with the hospice.  85 Delayed recertification of hospice terminal illness  Code indicates the hospice received the recertification of terminal illness later than 2 days after the first day of a new benefit period.  This code is reported with occurrence span code 77, which reports the provider liable days associated with the untim ely recertification.   Occurrence Codes and Dates   The hospice enters any appropriate NUBC approved code(s)  and associated  date(s)  defining specific event(s)  relating  to this billing  period.  Event  codes  are two numeric  digits,  and dates  are six  numeric  digits  (MM -DD-YY).   If there are more  occurrences  than there are  spaces  on the  form,  use the occurrence span code fields  to record  additional  occurrences  and dates.   Codes listed below are only those most frequently applicable to hospice claims.  For a complete list of codes, see the NUBC manual.   Code  Title  Definition  23 Cancellation  of Hospice  Election  Period  (A/B MAC (HHH)  USE  ONLY)  Code  indicates  date on which  a hospice  period  of election  is cancelled  by an  A/B MAC (HHH)  as opposed to  revocation by the  beneficiary.  24 Date Insurance Denied  Code indicates the date of receipt of a denial of coverage by a higher priority payer.  27 Date  of Hospice  Certification  or Re-Certification  Code  indicates  the date of certification or  re-certification  of the hospice  benefit  period, beginning with  the first 2 initial benefit  periods  of 90 days  each  and the subsequent  60-day benefit  periods.  NOTE:  regarding transfers from one hospice to another hospice:  If a patient is in the first certification period when they transfer to another hospice, the receiving hospice would use the same certification date as the previous hospice until the next certifica tion period.  However, if they were in the next certification at the time of transfer, then they would enter that date in the Occurrence Code 27 and date.  42 Date of Termination of Hospice Benefit  Enter  code  to indicate  the date on which  beneficiary  terminated  his/her  election  to receive hospice  benefits.   This code can be used only when the Code  Title  Definition  beneficiary has revoked the benefit.  It is not  used in transfer situations.  55 Beneficiary is Deceased  Report the appropriate NUBC discharge status code that best describes the place in which the beneficiary died (40, 41, or 42). Discharge status code 20 is not used on hospice claims.   Occurrence code 27 is required on the claim for the billing period in which the certification or re -certification was obtained.  It may be optionally reported on other claims.    When the re- certification is late and not obtained during the month it was due, the occurrence span code 77 should be reported with the through date of the span code equal to the through date of the claim.  Occurrence Span Code and Dates  The hospice enters any appropriate NUBC approved code(s)  and associated  beginning and ending date(s)  defining a  specific event  relating  to this billing  period are shown.  Event  codes  are two alphanumeric digits  and dates  are shown numerically  as MM- DD-YY.  Codes listed below are only those most frequently applicable to hospice claims.  For a complete list of codes, see the NUBC manual.   Code  Title  Definition  M2 Dates  of Inpatient  Respite  Care  Code  indicates  From/Through  dates  of a period  of inpatient  respite  care for hospice  patients to differentiate separate respite periods of less than 5 days each.  M2 is used when respite care is provided more than once during a billing  period.  77 Provider Liability Utilization Charged  Code indicates From/Through dates for a period of non-covered hospice care for which the provider accepts payment liability (other than for medical necessity or custodial care).   Respite care is payable only for periods of respite up to 5 consecutive days.  Claims reporting respite periods greater than 5 consecutive days will be returned to the provider.  Days of respite care beyond 5 days must be billed at the appropriate home care rate for payment consideration.  For example:  If the patient enters a respite period on July 1 and is returned to routine home care on July 6, the units of respite reported on the line item would be 5 representing July 1 through July 5, July 6 is reported as a day of routine home care re gardless of the time of day entering respite or returning to routine home care.  When there is more than one respite period in the billing period, the provider must include the M2 occurrence span code for all periods of respite.  The individual respite periods reported shall not exceed 5 days, including consecutive respite periods.  For example:  If the patient enters a respite period on July 1 and is returned to routine home care on July 6 and later returns to respite care from July 15 to July 18, and completes the month on routine home care, the provider must report two separate line items for the respite periods and two occurrence span code M2, as follows:  Revenue Line items:   Revenue code 0655 with line item date of service 07/01/XX (for respite period July 1 through July 5) and line item units reported as 5   Revenue code 0651 with line item date of service 07/06/XX (for routine home care July 6 through July 14) and line item units reported as 9    Revenue code 0655 with line item date of service 07/15/XX (for respite period July 15 through 17th) and line item units reported as 3   Revenue code 0651 with line item date of service 07/18/XX (for routine home care on date of discharge from respite through July 31 and line item units reported as 14.  Occurrence Span Codes: