Healthcare Provider Solutions

HOSPICE UNTIMELY NOE

With the new timely filing deadline for the filing and acceptance of the Notice of Election (NOE) documents there are reimbursement issues that occur when those timely filing dates are not met.

In instances where a NOE is not timely-filed, the Medicare contractor 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 Medicare contractor. These days shall be a provider liability, and the provider shall not bill the beneficiary for them. Example: Election/Admission date is 01/01/15 and the NOE is not accepted at the MAC until 01/10/15. The noncovered days would be 01/01/15 through 01/09/15.

When the hospice did not file the NOE timely, it may request an exception. Examples of valid qualifying exceptions are as follows:

  • Fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate
  • An event that produces a data filing problem due to a Centers for Medicare & Medicaid Services (CMS) or Medicare contractor systems issue that is beyond the control of the hospice. Example: sequential billing requirements that require a second hospice to remove its timely filing NOE and claims so a previous provider can bill
  • 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’ Medicare contractor or
  • Other circumstances determined by the Medicare contractor or the CMS to be beyond the control of the hospice. This exception will be evaluated on a case by case basis.*

*This exception applies when a previous hospice fails to file their final/revocation claim timely and therefore causes the subsequent hospice to be untimely with filing the new NOE.

When the hospice qualifies for one of the exceptions above there are specific edits that must be made on the claims in order for the exception to be applied and the claim to be paid. The two primary occasions that will most typically be applicable are number 3& 4 above.

The Medicare Administrative Contractors (MACs) have created an NOE Timely Filing Job Aid to which explains each exception and how it should be handled on the claim. Click here to access this job aid.

HOSPICE CAP SELF REPORTING

There has been much confusion regarding the new requirement in 2015 for ALL Hospices to SELF report their aggregate cap calculation for 2014 and deal with any overpayment by March 31, 2015. CMS had promised to issue a template to assist hospices in this self report and has finally released the template. The template has been sent to the Medicare MACs and will be released by the MACs very soon. The main reason for the delay in the release of the template was not knowing how to deal with the 2% sequester when tabulating the self report amounts. CMS has decided that hospices will not take the sequester into account when self reporting, but when the MAC makes that final cap determination the sequester will applied.

PLEASE NOTE THAT FAILURE TO SUBMIT YOUR CAP CALCULATION (and address any overpayment) BY THE MARCH 31 DUE DATE COULD RESULT IN SUSPENSION OF HOSPICE PAYMENTS.

We are aware that some hospices are not able to secure their P S & R data because they were not active in the system when the IACS to EIDM transition began. Palmetto has begun to send letters to hospices that include the data needed to complete the self-calculation of the aggregate cap. The other MACs – NGS and CGS – have indicated that they will consider requests from hospices for the P S & R data needed to self-calculate the cap on a CASE BY CASE BASIS.

NGS requests should be sent to: PS&R@anthem.com

CGS requests should be submitted to the general Provider Contact Center number: 877-299-4500 (Option 1) and referrals will be made to the Provider Audit department for assistance.

If you are currently a NAHC member you should be able to obtain the template from www.nahc.org or the NAHC listserves.