Hospice Claims Filing
The Medicare hospice benefit requires that providers submit two types of billing transactions: the Notice of Election (NOE) and the claim. The NOE (an abbreviated claim) is submitted to notify the Medicare contractor, and the Common Working File (CWF), of the start date of the beneficiary’s election to the hospice benefit. The NOE is submitted after the beneficiary has signed the election statement and is only submitted once.
The first claim is submitted only after the NOE has processed. Before billing the first claim to Medicare, review the sequential billing requirements. Hospice claims must be submitted and processed in date order. After the first claim processes, the subsequent claim can then be submitted. Claims must also be submitted monthly and should not span a two month period. For example, claims for September and October must be submitted separately due to changes in reimbursement rates. Claims for October and November must also be submitted separately due to the end of the hospice “cap period”.
The Fiscal Intermediary Standard System (FISS) Claims/ Attachments option (FISS Main Menu option 02) allows you to enter NOEs and hospice claims. The following provides screen prints and field descriptions for each of the six FISS claim pages and identifies which page/fields are required for NOEs and hospice claims. For more detailed information about FISS, refer to the Chapters 1-5 of the FISS Guide.
Notice of Elections (NOEs)
Hospice Claims
Special Hospice Claims Filing Situations
- Canceling a Notice of Election or Benefit Period
- Transferring Beneficiary From/To Another Hospice Agency
- Change of Ownership
- Discharge or Revocation of Hospice Care
- Add-on (Late Charges) Claim (for dates of service prior to 4/1/2012)
- Occurrence Code 42 Omitted (for dates of service prior to 1/1/2012)
- Requests for Medical Denials
- Influenza Vaccines and Hospice
- Untimely Recertifications and Occurrence Span Code (OSC) 77
Additional Resources
This CMS fact sheet offers an overview of the UB-04, also known as the Form-1450, which is the uniform institutional provider hardcopy claim form suitable for use in billing multiple third party payers
Section 6404 of the Patient Protection and Affordable Care Act (PPACA) amended the timely filing requirements to reduce the maximum time period for submission of all Medicare claims, including adjustments and cancels, to one calendar year after the date of service.
Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 11)
Chapter 11 of the Medicare Claims Processing Manual provides information about the Medicare hospice benefit including billing and payment of hospice and physician services, and the hospice cap and limitations.
National Uniform Billing Committee (NUBC)
Refer to the NUBC web site for a complete description of all the items included on the CMS-1450 (UB-04) claim form.
A variety of tools developed by the CGS Provider Outreach and Education staff are available to assis in the successful processing of your claims.
Updated: 03.14.12
