(Medicare Claims Processing Manual)

A change of ownership notice is used when the beneficiary will remain with the same hospice, but the person or group running the hospice is changing. A change of ownership typically occurs when a Medicare provider has been purchased (or leased) by another organization.    Type of Bill    Enter the appropriate 3 -digit numeric type of bill code, according to the following code structure:   81E -  Hospice (Nonhospital -Based) Change of Ownership   82E -  Hospice (Hospital -Based) Change of Ownership   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    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.   The date of admission may not precede the physicians certification by more than 2 calendar days, and is the same as the certification date if the certification is not completed on time.   EXAMPLE   The hospice election date (admission) is January 1, 2014. The physicians certification is dated January 3, 2014. The hospice date for coverage and billing is January 1, 2014. The first hospice benefit period ends 90 days from January 1, 2014. Show the month, day, and year numerically as MM -DD-YY.   Condition Codes    Condition codes are not required on an original change of ownership notice. If the hospice is correcting the effective date of a change using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the transfe r notice will be returned to the hospice.   Occurrence Codes and Dates    Hospices may submit a change of ownership notice that corrects the effective date of a change previously submitted in error. In this case, the hospice reports the correct effective date of the change of ownership in the From Date field and reports the original, incorrect effective date using occurrence code 56. Medicare systems use the original, incorrect date to find the benefit period to be corrected, then replaces the effective date of the change of ownership with the corrected information.   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. When a hospice agency changes ownership and a new Medicare provider number issued, the A/B Medicare Administrative Contractor (MAC) must be notified to update the provider number in the hospice period. This will avoid mistaking the change as a beneficiary -elected transfer.   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 medica l 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.   20.1.6 Hospice Election Periods and Benefit Periods in Medicare Systems (Rev. 4280, Issued: 04- 19-2019, Effective: 07 -21-19, Implementation: 07- 21-19)  Election Periods   An election period as described in CFR 418.21 is the initial 90- day period, subsequent 90-day period; or an unlimited number of subsequent 60- day periods. In the Medicare systems the term election period is used to describe the overall period between a n election and revocation, which may include multiple 90- day or 60 -day periods.   Medicare systems refer to the 90 -day or 60 -day periods as benefit periods.   Therefore, hospices should be aware that when they see references to election periods in regulation or in the Medicare Benefit Policy Manual, they are referring to what is called a benefit period for purposes of claims processing.   Hospice election and revocation date information are stored in a separate election period in Medicare systems from benefit period information, so the two types of information can be changed independently. Both election periods and benefit periods are store d in Medicares Common Working File (CWF) and can be viewed via inquiry screens.  When a hospice submits an NOE (TOB 8xA), Medicare systems create an election period.  The election period file for each beneficiary contains the following data elements for each of their election periods:    Period Number  a sequential number assigned to each election period     Elect Date  the date of election reported in the From date of the NOE    Receipt Date  the receipt date of the NOE that created the election period    Revoc Date the revocation date reported in the Through date of the NOTR or of a discharge claim    Revoc Ind  a revocation indicator assigned when the revocation date is recorded    Provider  the CMS Certification Number (CCN) of the hospice that submitted the NOE    NPI  the National Provider Identifier of the hospice that submitted the NOE.  When an 8xA is processed, the election date and receipt date will be updated on the election period CWF inquiry screen.  The revocation date remains blank and the revocation indicator is 0.   The NOE receipt date will be retained on the election period permanently. If benefit periods are cancelled, this will not remove the NOE receipt date from Medicare systems. If the election date is changed using the occurrence code 56/condition code D0 proc ess described above, the NOE receipt date will not change.  When a hospice submits an NOTR (TOB 8xB), Medicare systems will post a revocation date on the election period and change the revocation indicator to 1.  Similarly, if a revocation date is corrected using the 56/D0 process, the correct date will be displaye d on the election period.   If the hospice files the discharge claim in lieu of the NOTR, the claim will also post the revocation date and revocation indicator on the election period, in addition to updating the Term Date1 of the benefit period to match the revocation date.   A later NOE for the same beneficiary when there is no revocation date on the election period will be rejected.  Consistent submission of revocations, via NOTRs or claims, within 5 days of the revocation date as required by regulation, is very important to prevent this.   When a hospice submits a Change of Provider/Transfer Notice (TOB 8xC) or a Change of Ownership Notice (TOB 8xE), this will make no changes to the election period.  Benefit Periods   The hospice benefit period file pre -existed the episode period file and retains all the same fields it had historically, but election -related fields on those screens will no longer be used.   The hospice benefit period file for each beneficiary contains the following data elements for each of the benefit periods they use while receiving hospice care:    Start Date1  the start date of the benefit period    Term Date1 -- the end date of the benefit period    Prov1 -- the CCN of the hospice whose claim created the benefit period    Inter1 a number identifying the Medicare Administrative Contractor serving Prov1   DOEBA Date  date of earliest billing activity, the first date billed in the period    DOLBA Date  date of latest billing activity, the Through date of the last claim processed in the period.    Days Used  the number of days in the period used to date    Start Date2  the effective dates of a transfer during the period    Prov2 -- the CCN of the hospice from the 8xC transfer notice.    Inter2 -- a number identifying the Medicare Administrative Contractor serving Prov1   Revocation Ind  no longer used.   Benefit period contain two columns of information.  One captures information on the original billing hospice and any hospice receiving a transfer.  A second column, labelled Owner Change captures information about a change of ownership to either of these  hospices.   Benefit periods are created by submitting claims. Benefit period information supports claims processing functions only, while the election period carries only the beneficiarys election status.  If a hospice needs to cancel all the claims in a benefit period, Medicare systems will remove the hospice benefit period.      The first claim submitted by the hospice after an election must ensure the From and Admission dates match the election period start date. This will ensure the first benefit period in the election is created correctly and subsequent claims will process.  When a hospice submits a Change of Provider/Transfer Notice (TOB 8xC) or a Change of Ownership Notice (TOB 8xE), this will post the Start Date2 and Prov2 information on the hospice benefit period.  When a hospice submits a Change of Ownership Notice (TOB 8xE), this will post an Owner Change start date on the benefit period.      Summary Chart   The following chart provides a reference to help hospices understand which of their submissions will impact an election period or a benefit period.    Effects of Election Periods    Effects of Benefits Periods