evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Group Code: CO  CARC: 109  RARC: N/A  MSN: 17.9  20 - Hospice Notice of Election  (Rev. 1, 10- 01-03) HSP-201  20.1 - Procedures for Hospice Election  and Related Transactions  (Rev.  3866, Issued: 09- 26-17, Effective: 01- 01-18, Implementation: 01- 02-18)  See Chapter 9 of the Medicare Benefit Policy Manual for hospice eligibility requirements and election of hospice care.   20.1.1 - Notice of Election (NOE)  (Rev. 12083; Issued: 06- 15-23; Effective: 05 -15-23; Implementation: 07- 17-23)  When a Medicare beneficiary elects hospice services, hospices must complete the data elements identified below for the Uniform (Institutional Provider) Bill (Form CMS -1450) or its electronic equivalent, which is a Notice of Election (NOE).   Timely -filed hospice NOEs shall be filed within 5 calendar days after the hospice admission date. A timely -filed NOE is a NOE that is submitted to the A/B MAC (HHH) and accepted by the A/B MAC (HHH) within 5 calendar days after the hospice admission date. While a timely -filed NOE is one that is submitted to and accepted by the Medicare contractor A/B MAC (HHH) within 5 calendar days after the hospice election, posting to the CWF may not occur within that same time frame. The date of posting to the CWF is not a reflection of whether the NOE is considered timely -filed. In instances where a NOE is not timely -filed, Medicare shall not cover and pay for the days of hospice care from the hospice admission date to the date the NOE is submitted to, and accepted by, the A/B MAC (HHH). These days shall be a provider liability, and the provider shall not bill the beneficiary for them. The hospice shall report these non- covered days on the claim with an occurrence span code 77, and charges for all claim lines reporting t hese days shall be reported as non- covered, or the claim will be returned to the provider.
(Medicare Claims Processing Manual)
If a hospice fails to file a timely -filed NOE, it may request an exception which, if approved, waives the consequences of filing a NOE late. The four circumstances that may qualify the hospice for an exception to the consequences of filing the NOE more than 5 calendar days after the hospice admission date are as follows:   1. fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospices ability to operate;   2. an event that produces a data filing problem due to a CMS or A/B MAC (HHH) systems issue that is beyond the control of the hospice;   3. a newly Medicare -certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its A/B MAC (HHH); or,   4. other circumstances determined by the A/B MAC (HHH) or CMS to be beyond the control of the hospice.  If one of the four circumstances described above prevents a hospice from filing a timely-  filed NOE, the hospice may request an exception which, if approved, would waive the consequences of filing the NOE late.   When an NOE is submitted within the five day timely filing period, but the NOE contains inadvertent errors (such as a beneficiary identifier that has recently changed), the error does not trigger the NOE to be immediately returned to the hospice for correc tion. In these instances, the hospice must wait until the incorrect information is fully processed by Medicare systems before the NOE is returned to the hospice for correction.  There are other NOE errors, such as an incorrect admission date, that will not be returned for correction and instead must be finalized and posted by the Medicare systems before the hospice can correct the NOE. Only the hospice is aware of the error. Such delays in Medicare systems could cause the NOE to be late.
(Medicare Claims Processing Manual)
Delays due to Medicare system constraints are outside the control of the hospice and may qualify for an exception to the timely filing requirement.  Hospices can reduce the number of errors and exception requests related changes to the beneficiary identifier by performing an eligibility check immediately before admission.  This can confirm that the Medicare Beneficiary Identifier (MBI) is active and ac curate since the eligibility inquiry system contains an MBI End Date field.    If there is a date in that field, the MBI is not valid after that date.  The hospice can contact the beneficiary or use the MBI Lookup tool to determine the current MBI to use on the NOE.   Since correct beneficiary identifier information is available to the hospice, only changes that occur shortly before the admission are beyond the hospice control.  A/B MAC (HHH) MACs will not grant exceptions based on MBI changes that were accessible to the hospice more than two weeks prior to the admission date.   Medicare contractors shall grant an exception for the late NOE if the hospice is able to provide documentation showing:   (1) When the original NOE was submitted;   (2) When the NOE was returned to the hospice for correction or was accepted and available for correction and;   (3) Evidence the hospice resubmitted the returned NOE within two business days of when it was available for correction or cancelled an accepted NOE within two business days and submitted the new NOE within two business days after the date that the cancellation  NOE finalized.   The hospice shall provide sufficient information in the Remarks section of its claim to allow the contractor to research the case. If the remarks are not sufficient, Medicare contractors shall request documentation. Documentation should consist of printout s or screen images of any Medicare systems screens that contain the information shown above.  Medicare contractors shall not grant exceptions if:  the hospice can correct the NOE without waiting for Medicare systems actions   the hospice submits a partial NOE to fulfill the timely -filing requirement, or  hospices with multiple provider identifiers submit the identifier of a location that did not actually provide the service
(Medicare Claims Processing Manual)
In the great majority of cases, the five day timely filing period allows enough time to submit NOEs on a day when Medicare systems are available (i.e. the period allows for ("dark days"). Additionally, the receipt date is typically applied to the NOE immediately upon submission to Medicare systems, so subsequent dark days would not affect the determination of timeliness. However, f the hospice can provide documentation showing an NOE is submitted on the day before a dark day period and the NOE does not rece ive a receipt date until the day following the dark days, the contractor shall grant an exception to the timely filing requirement. CMS expects these cases to be very rare.   Hospices must send the NOE to the A/B MAC (HHH) by mail, electronic data interchange (EDI), or direct data entry (DDE) depending upon the arrangements with the A/B MAC (HHH). EDI submissions require additional data not required by the NOE itself, to satisf y transaction standards. This data is described in a companion guide available on the CMS website at www.cms.gov/Medicare/Medicare- Fee-for-Service- Payment/Hospice/index.html . Hospices may voluntarily agree to adopt the companion guide and use it to submit EDI NOEs at any time.  If a patient enters hospice care before the month he/she becomes entitled to Medicare benefits, e.g., before age 65, the hospice should not send the NOE before the first day of the month in which he/she becomes 65.  Hospices complete the following data elements when submitting an NOE.  Provider Name, Address, and Telephone Number   The minimum entry for this item is the providers name, city, State, and ZIP code. The post office box number or street name and number may be included. The State may be abbreviated using standard post office abbreviations. Five or 9- digit ZIP codes are acceptable. Use the information to reconcile provider number discrepancies. Phone and/or FAX numbers are desirable.   Type of Bill   Enter the appropriate 3 -digit numeric type of bill code, according to the following code structure:   81A -  Hospice (Nonhospital -Based) Initial Election Notice  82A -  Hospice (Hospital -Based) Initial Election Notice    Statement Covers Period (From -Through)
(Medicare Claims Processing Manual)
81A -  Hospice (Nonhospital -Based) Initial Election Notice  82A -  Hospice (Hospital -Based) Initial Election Notice    Statement Covers Period (From -Through)   The hospice enters the From date of this hospice election. A Through date is not required on NOEs.   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. 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.   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 NOE. If the hospice is correcting an election date using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the NOE will be returned to the hospice.  Occurrence Codes and Dates   The hospice reports occurrence code 27 and the date of certification. This date must match the From Date and Admission Date.
(Medicare Claims Processing Manual)
The hospice reports occurrence code 27 and the date of certification. This date must match the From Date and Admission Date.   Hospices may submit an NOE that corrects an election date previously submitted in error. In this case, the hospice reports the correct election date in the From Date, Admission Date and occurrence code 27 fields and reports the original, incorrect election date using occurrence code 56. Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that election date with the corrected information.   Release of Information   Valid values are:      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 I- Informed  consent to  release  medical  information  for condition or diagn  regulated  by Federal  Statutes  Y -Yes, provider  has a signed  statement  permitting  release  of information   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
(Medicare Claims Processing Manual)
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.  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)
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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)