A Review of MLN SE18007: Recent & Upcoming Improvements in Hospice Billing & Claims Processing Ask-the-Contractor Teleconference (ACT)
View the handoutfor the October 4, 2018, A Review of MLN SE18007: Recent & Upcoming Improvements in Hospice Billing & Claims Processing Ask-the-Contractor Teleconference (ACT).
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- What date do we use for the “From” date on a revocation/discharge (original start of care (SOC) date or the Notice of Election (NOE) of current benefit date)?
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We are assuming the provider means the Notice of Termination/Revocation (NOTR) type of bill 8XB. Providers should use the original start date of the NOE on the election screen. They no longer use the benefit period (BP) start date.
Published: 10.29.18
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- Is there an ETA on any resolution of issues due to redesign of CWF?
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Based on the Claims Processing Issues Log (CPIL), it appears most of the redesign issues have been resolved with the October release. If this is not the case, the CPIL will be updated as appropriate.
Published: 10.29.18
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- When will the routine home care (RHC) overpayment issue be resolved? Is there anything providers can do to resolve their own claims with this issue?
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This issue was scheduled to be resolved with the October release. Providers may adjust their claims, and if they pay incorrectly they will need to notify the Provider Contact Center (PCC). Please refer to Claims Processing Issues Log (CPIL) for status and updates.
Published: 10.29.18
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- Can we still enter NOEs or NOTRs through the Direct Data Entry (DDE)?
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Yes, there is no process change here. The EDI option is an addition to the traditional submission methods.
Published: 10.29.18
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- What is a benefit period?
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Medicare eligible patients are entitled to 2-90 day and unlimited 60 day periods.
Published: 10.29.18
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- Does oxygen need to be reported? I did not see Rev 270 as reportable.
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No, oxygen is not reported on hospice claims. Please refer to the article, MM10573: Enhancements to Processing of Hospice Routine Home Care Payments, found in the July 2018 HHH Medicare Bulletin for additional information regarding drug reporting on hospice claims.
Published: 10.29.18
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- Without a submitter ID and DDE user name and password how do you submit your NOE?
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In this situation, you would need to submit your NOE via paper or via EDI.
Published: 10.29.18
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- Is this presentation online for future review?
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Yes, the recorded presentation is available on the HHH Recorded Webinars Web page.
Published: 10.29.18
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- If NOEs do not set up Benefit Periods, why do they still go to RTP for U5106?
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The system will no longer allow a provider to submit an NOE when the previous hospice has not posted a revocation. This edit is based of the election screen. This edit will also hit if the provider bills an 8XA and should have billed an 8XC.
Published: 10.29.18
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- I have another provider blocking my billing and they are billing in the wrong Benefit Period. This is creating a billing issue with having to request that the provider remove their bills only and wait to submit their claim in the correct benefit period. This will cause the possibility to enter the patient in the wrong benefit period missing a face to face (F2F) or doing a F2F when it is not needed.
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In this case, the best suggestion is to make sure there is a current F2F on file for the entire timeframe. If the BPs are off, the provider should document what occurred in their medical records explaining why they are off. Providers absolutely have to have a F2F that is current for the billing timeframe.
Published: 10.29.18
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- How do you remove a 8XD entered in error?
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You can’t remove an 8XD entered in error. The provider would have to rebill.
Published: 10.29.18
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- You aren't answering questions today?
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For this event, as marketed, we are only addressing the pre-submitted questions during the teleconference. However, all questions, those pre-submitted and those asked during the event, will be addressed and posted to our website.
Published: 10.29.18
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- A patient was admitted in their 3rd Medicare Benefit on a Sunday, however, we did not have a NP, MD, or DO to perform a F-2-F on 09/30/2018. F-2-F performed 10/01/2018. NOE was submitted on 09/30/2018 and the F-2-F was completed on 10/01/2018. 1. What is the certification period? 2. Does our agency qualify for the exception?
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In cases where a patient is an emergency weekend admission and it’s not possible for a hospice physician or NP to see the patient until the following Monday, a face to face encounter which occurs within 2 days after admission will be considered to be timely. The certification date would be 09/30/2018. If the face to face was not completed within 2 days, Medicare would expect the hospice to discharge the patient and continue to care for the patient until the required encounter occurs. Refer to the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 9, Section 20.1 for additional information. The situation described wouldn’t qualify for an approved exception.
Published: 10.29.18
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- Who submits the annual DDE certification, anyone or just the administrator?
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Anyone with a DDE ID may submit the annual certification. Refer to the article, Annual Recertification Due by September 30th for more information.
Published: 10.29.18
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- If the third party provider we are required to have to submit claim electronically, goes down for a couple days after we submit our NOE electronic or can not submit due to that. Is that considered an exception to the NOE 5 day rule? Or do we just enter in FISS.
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Our suggestion is to enter in FISS in these situations as this would not be an allowed exception.
Published: 10.29.18
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- If a hospice changes ownership but the NPI and PTAN remain the same, does a NOTR have to be submitted if the patient is continuing service?
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If the PTAN remains the same the new hospice just continues billing as normal. The NOTR would not be billed until the patient revoked benefits.
Published: 10.29.18
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- Can the OCC code 56 and condition code D0 be entered from RTP?
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If the notice that was returned was actually intended to correct an NOE or NOTR, then yes providers should be able to add the D0 and OCC 56 and date as applicable.
Published: 10.29.18
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