(Medicare Claims Processing Manual)

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   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.  In transfer situations, the receiving hospice should use their own admission date.  When a new hospice admission occurs after a hospice revocation or discharge that resulted in termination of the hospice benefit, the new admission date cannot be the same as the revocation or discharge date of the previous benefit period.  Show the month, day, and year numerically as MM- DD-YY.  Condition Codes   Condition codes are not required on an original transfer notice.   If the hospice is correcting a date of transfer using occurrence code 56, the hospice reports condition code D0.  If the two codes are not reported together, the transfer notice will be returned to the hospice.   Occurrence Codes and Dates   An occurrence code 27 is not required on a transfer notice, unless the date of transfer is also the first day of the next benefit period.  Hospices may submit a transfer notice that corrects a date of transfer previously submitted in error.  In this case, the hospice reports the correct effective date of the transfer in the From Date field and reports the original, incorrect effective date us ing occurrence code 56.  Medicare systems use the original, incorrect date to find the benefit period to be corrected, then replaces that date of transfer 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.   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 physician 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 phys ician 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.   20.1.4  Cancellation of an Election  (Rev. 12083; Issued: 06- 15-23; Effective: 05 -15-23; Implementation: 07- 17-23)  A cancellation notice is used when the beneficiary will not be receiving services from the hospice, but the admission date has already been entered. The entered dates will be voided since the beneficiary never participated with the hospice.   A cancellation notice removes the hospice election period that was created by an NOE. Cancellation notices are not needed to remove hospice benefit periods, which are automatically removed when all claims in the benefit period are cancelled. See section 20.1.6.   Cancellation notices can also be used to remove a transfer or a change of ownership that was submitted in error.   Type of Bill    Enter the appropriate 3 -digit numeric type of bill code, according to the following code structure:   81D -  Hospice (Nonhospital -Based) Void/Cancel hospice election   82D -  Hospice (Hospital -Based) Void/Cancel hospice election   Statement Covers Period (From -Through)    When there is no change in the provider number during the election, the hospice enters the election date of the election period that is being canceled. No through date is required. Any claims processed during the election must be cancelled before an electi on period can be removed.   When there has been a transfer or change of ownership, the From date on the 8xD must match the corresponding transfer or change date to ensure those dates are removed correctly.   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    Show the month, day, and year numerically as MM -DD-YY.   When there has been a transfer or change of ownership, the admit date on the 8xD must match the corresponding transfer or change date to ensure those dates are removed correctly.   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.   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 physician 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. If the beneficiary is transferred to another hos pice (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.   20.1.5  Change of Ownership Notice  (Rev. 12083; Issued: 06- 15-23; Effective: 05 -15-23; Implementation: 07- 17-23)  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.