Notices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC.  There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.  This situation typically arises when there is a technical error on the claim such as transposing numbers or the transposing of names, such as first name being entered as the patient’s last name, etc.  The issues also include the hospice filing a NOE with incorrect admission/benefit period dates and this error is not recognized by the MAC system and therefore hospice cannot correct until the MAC has fully processed the NOE.  In these situations the MAC systems do not immediately return the NOE for correction and therefore delays the agency’s correction time and in most cases causes an untimely NOE and negative reimbursement implications to the hospice.

Relief has now been granted in some circumstances, but this requires TIMELY correction on the hospice’s part.  In MLN Matters SE1633 the following has been stated:

Medicare has determined that timely-filed NOEs with inadvertent errors that cannot be immediately corrected due to Medicare system constraints (and thus returned to the provider for correction, causing late system acceptance of NOEs and non-covered days) are outside the control of the hospice and so qualify for an exception to the timely filing requirement in the circumstances described below. All current provider education about errors that can be fixed immediately remain in effect. MACs will grant an exception only for instances where timely-filed NOEs contained errors that could not be immediately corrected due to system constraints.

MACs will grant an exception for the late NOE if the hospice is able to provide the MAC with 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) When the hospice resubmitted the NOE.

MACs will grant the exception if all documentation is provided and the hospice took appropriate actions within 2 business days to make corrections. Once the NOE is returned for correction the hospice will have 2 business days to resubmit. When the NOE was posted to the Common Working File (CWF) and must be cancelled and resubmitted, they will have 2 business days to cancel the NOE and then 2 business days to submit the new NOE after the date that the cancellation NOE finalizes.

MACs have previously educated that hospices need not wait until an NOE is returned to correct many errors. In these instances, an exception will not be granted. It is not appropriate for hospices to submit a partial NOE to fulfill the timely-filing requirement. MACs will not grant exceptions in cases where it appears that the hospice is engaging in such practices.

Key thing for hospice staff to remember is that this is an issue requiring timely action on behalf of the hospice. Someone must monitor the CWF/DDE systems and ensure that timely action is taken once the NOE is processed by the MAC.  Delays in the reprocessing of the NOE will not be granted the exception.