Change Request 8877 Frequently Asked Questions

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• Change Request 8877: Updates from CGS on Timely Filing of NOEs and Exception Requests Ask-the-Contractor Teleconference (ACT), February 18, 2015
• Change Request 8877 Ask-the-Contractor Teleconference (ACT), September 24, 2014

General Questions about CR 8877

1. The effective date of this Change Request is October 1, 2014. Does that apply only to new admissions?

   • Based on the CR, the 5-day timely filing of the NOE applies to any new hospice admission that occurs on/after October 1, 2014. In addition, the 5-day timely filing of the NOTR applies to any live discharge/revocation that occurs on/after October 1, 2014.

     Reviewed: 03.16.17

2. How does a Medicare Secondary Payer (MSP) situation affect the requirements in CR 8877?

   • The requirements in CR 8877 still apply, even when a patient has another insurer that is primary to Medicare. This means that the NOE and NOTR must still be submitted timely as indicated in CR 8877. As a reminder, MSP information should not be submitted on an NOE or NOTR.

     Reviewed: 03.16.17

3. Are hospice transfers and the billing of 81C or 82C subject to the 5-day timely filing requirement?

   • No, a hospice transfer is a continuation of a hospice benefit period. Therefore, hospice transfers and the submission of 8XC transactions are not subject to the 5-day timely filing requirement mandated by Change Request 8877.

     Reviewed: 03.16.17

4. Does CR 8877 include regulations for changes of ownership (CHOW)?

   • For a change of ownership (CHOW), NOEs and sequential claims should continue to be submitted timely. The seller and buyer should come to an agreement to continue billing until the CHOW finalizes. NOEs for dates prior to the effective date of the CHOW do not need to be cancelled. Exceptions for late NOEs after the CHOW effective date may be approved on a case by case basis.

     Reviewed: 03.16.17

Timely Filing of Notices of Election (NOE)

1. How will a hospice know when the NOE/NOTR was 'accepted' by the MAC, i.e. the date of acceptance?

   • When the NOE is submitted, FISS will assign a receipt date (REC DT) to the NOE. If, however, an error is identified on the NOE (billing/keying error), or the NOE edits against an open hospice benefit period, or other beneficiary eligibility information, it will be returned the provider (RTPd) or rejected. If an NOE is RTPd, it will receive a new REC DT when it is corrected. This new REC DT will be the date used to determine whether the NOE was submitted timely. For additional guidance, refer to the "Submitting Claims for Untimely Notices of Election (NOEs)" web page.

     Reviewed: 03.16.17

2. Is an NOE considered accepted when it reaches PB9997 or when it is submitted as long as it has no errors?

   • An NOE does not need to reach P B9997 to be considered accepted. If the NOE is received in FISS within 5 calendar days after the hospice admission, and the NOE contains no errors (is not returned to the provider (RTPd) or rejected), the NOE is considered timely.

     Reviewed: 03.16.17

3. CR 8877 says that the NOE must be submitted to and accepted by the Medicare contractor within 5 calendar days after the hospice admission date. What does "accepted" mean?

   • To be accepted by the MAC, the NOE/NOTR must be free of any billing/keying errors. When an NOE/NOTR is received in the FISS system, it will receive a "receipt date". In general, this will be the date the NOE/NOTR was received. However, if an NOE/NOTR is returned to the provider (RTPd), the NOE/NOTR will receive a new receipt date when it is corrected. In these cases, the "new receipt date" will be used to determine timely filing of the NOE/NOTR. An NOE does not need to be processed (P B9997) to be considered "accepted".

     Reviewed: 03.16.17

4. How should a provider handle a case where they must submit an NOE, but the prior hospice benefit period has not been terminated on CWF?
   • If a prior hospice benefit period has not been terminated at CWF, the hospice should still submit the NOE timely (within 5 days after admission). If the NOE cannot be processed because of a prior open benefit period, the hospice must still take the necessary steps to resolve the issues, which may include contacting the prior hospice agency, so the NOE can continue processing. Once the NOE has processed, and the provider is ready to submit the claim, if the provider believes the circumstance meets one of the exceptional circumstances, they can submit the claim with HCPCS modifier 'KX' to request an exception.  Effective with claims received on or after November 16, 2016, when submitting a 'KX' modifier, providers should provide sufficient information in the REMARKS field (FISS Page 04) that clearly indicates all the circumstances and time frames supporting the exception request.  If the REMARKS field is blank or the information is not clear, CGS will generate a non-medical additional development request.  In response to that request, the provider needs to submit documentation to support the reason why the NOE was not submitted/accepted timely. Hospice may consider taking screenprints in these types of situations.

     Reviewed: 03.16.17

5. If an NOE is submitted timely (within 5 days after admission), but is subsequently returned for correction (RTPd) and not corrected until after day 5, which date will be used to determine timeliness?

   • When an NOE is corrected out of the RTP file, it will receive a new receipt date. This new date will be used to determine timely submission of the NOE.

     Reviewed: 03.16.17

6. If we see that our NOE has an error and it will be past the 5th day before we can correct it, can we enter a new NOE with the corrections so we meet the 5 day rule?

   • Yes, if an NOE is submitted, and the provider determines the NOE contained a billing error and will RTP, a new NOE can be submitted. A provider does not need to wait for the incorrect NOE to RTP before submitting a new NOE. The new NOE will be considered timely if submitted within the 5 days. However, if the initial NOE processes without RTPing, the new (correct) NOE will not process, and this situation would not qualify as an exceptional circumstance.

     Reviewed: 03.16.17

7. If an NOE was submitted timely, but information on the NOE is determined to be incorrect (physician name, diagnosis code, etc.) what action should be taken and will the NOE that was filed initially meet the timely filing requirement?

   • If the information has simply changed (certifying physician changed or diagnosis code changed), or a keying error occurred, you do not need to cancel the NOE. Corrections to diagnosis codes and certifying physicians on the NOE may be made on subsequent claims.

     Since there is no editing in Medicare Systems that ensures the diagnosis codes and certifying physicians on hospice claims match the NOE, hospices can correct diagnosis coding and certifying physician errors on subsequent claims, without canceling the NOE.

     Reviewed: 08.01.16

8. If the NOE is submitted untimely, should the hospice bill from the election/cert date to the end of the month and the MAC will adjust for the liable days? Or should the provider report the days as "provider liable"?

   • If the NOE is submitted untimely (more than 5 calendar days after the admission date), the level of care days from the date of admission to the day prior to receipt of the NOE, are reported as noncovered. Report occurrence span code (OSC) 77 on the first hospice claim, along with the noncovered dates (admit date, to day before the NOE's receipt date (REC DT)). In addition, the level of care days, visits, and drugs associated with the OSC 77 must be reported as noncovered.

     Example:

     Admit date = 101015 NOE receipt date = 101615 The claim must be submitted with OSC 77 and dates 101015-101515. The level of care days from 101015-101515 must be reported as noncovered. Any visits and drugs provided from 101015-101515 must also be reported as noncovered. If the noncovered days span into the next month, the subsequent claim should also reflect the noncovered days and include the OSC 77. Note: If the subsequent claim is billed with a KX modifier, the hospice should provide sufficient information in the REMARKS field (FISS Page 04) that clearly indicates all the circumstances and time frames supporting the exception request .  If there are no REMARKS or if they are not clear, a non-medical review additional development request (non-MR ADR) will be generated. The hospice will need to submit documentation supporting the exception request for the untimely NOE.

     For additional guidance, refer to the "Submitting Claims for Untimely Notices of Election (NOEs)" web page.

     Reviewed: 03.16.17

9. Will the Fiscal Intermediary Standard System (FISS) be available for NOE/NOTR entries on Sundays?

   • No, FISS is not available on Sundays or Federal holidays. Providers should consider this when calculating timely submission of the NOEs/NOTRs.

     Reviewed: 03.16.17

10. How long will it take to process an NOE, and is this processing time calculated in the 5-day timely filing of the NOE?

    • The processing time of an NOE can differ based on various factors. However, the date being used to determine if the NOE is timely is the receipt date (REC DT) assigned by FISS. Typically, this is the date the NOE was submitted in FISS. However, if the NOE is returned to the provider for correction (RTPd) and then corrected, a new receipt date is assigned by FISS, and this "new receipt date" will be the date used to determine timeliness of the NOE.

      Reviewed: 03.16.17

11. When reporting the noncovered days associated with the occurrence span code 77 (OSC 77), does each day need to be billed on a separate revenue code line, or can all the noncovered days be reported on one line, and the covered days reported on another line?

    • All noncovered days can be reported on a single revenue code line, unless there are multiple levels of care provided within the noncovered days. For additional guidance, refer to the "Submitting Claims for Untimely Notices of Election (NOEs)" web page.

      Reviewed: 03.16.17

Exception Process for Untimely NOEs

1. When a patient is discharged and readmitted several days later, the NOE will RTP if the previous benefit period is still open. Will the "readmit" NOE be considered untimely? Would this be an exceptional circumstance?
   • In cases where a beneficiary is discharged and readmitted within the current benefit period, the NOE will likely RTP if the prior benefit period has not been terminated. In these cases, the hospice should still submit their "readmission" NOE timely. If the NOE does RTP due to the open benefit period, this could justify an exceptional circumstance. Report OSC 77 on the claim, along with HCPCS modifier 'KX' if you are requesting an exception. If the 'KX' modifier is submitted, provide sufficient information in the REMARKS field (FISS Page 04) that clearly indicates all the circumstances and time frames supporting the exception request .  The decision on whether to grant the exception will be made once the information is reviewed.

     Note: If the patient is discharged and readmitted to the same hospice, the hospice must also submit the final claim or NOTR within 5 days after the discharge. Compliance with this requirement will also be considered during the review of the exception request. If the final claim or NOTR was not submitted timely, the exception request may be denied.

     Reviewed: 03.16.17

2. For a newly certified agency, NOEs will likely be untimely. Will the new hospice have to go through the exception process?

   • Yes, a newly certified hospice agency will need to submit their NOEs once they receive notification of the Medicare certification and security access to FISS. When submitting the initial claim for those beneficiaries who had untimely NOEs due to new certification, the provider would report occurrence span code 77 and HCPCS modifier 'KX' to indicate a request for an exceptional circumstance. The hospice will need to submit the letter they received showing their Medicare effective date, and the notification they received indicating when their FISS access was established.

     Reviewed: 03.16.17

3. If we are requesting an exceptional circumstance for an untimely NOE, what documentation is needed to support the exception?
   • Effective for claims received on or after November 16, 2016, providers should provide sufficient information in the REMARKS field (FISS Page 04) that clearly indicates all the circumstances and time frames supporting the exception request .  If the information in the REMARKS field is not clear, CGS will request additional documentation.  If requested, send any documentation that supports the reason why the NOE was untimely. In cases where the NOE could not process because a prior hospice benefit period had not been terminated, submit a dated screenprint of the beneficiary's eligibility record showing the open benefit period. In addition, any documentation to support your contact with, or attempts to contact, the prior hospice may also support the exceptional circumstance. In these cases, your documentation must show that the NOE was submitted timely, and subsequently RTPd or rejected because of the open hospice benefit period. If, upon review, CGS determines that the NOE was not initially submitted timely, the exception may not be granted.

     Reviewed: 03.16.17

4. A hospice claim is submitted and processed with occurrence span code 77, due to an untimely NOE. The hospice later determines that an exceptional circumstance occurred. Can the claim be adjusted (8X7) to report the HCPCS modifier 'KX' to request an exception?
   • Yes, if the claim was processed without the HCPCS modifier 'KX', and the provider later determines an exceptional circumstance has occurred, an adjustment claim can be submitted to report HCPCS modifier 'KX'. In addition, provide sufficient information in the REMARKS field (FISS Page 04) that clearly indicates all the circumstances and time frames supporting the exception request .  If the information in the REMARKS field is not clear, a non-medical review additional development request (non-MR ADR) will be generated to request documentation to support the exceptional circumstance.

     Reviewed: 03.16.17

5. How is documentation to support the exceptional circumstance submitted to CGS?

   • Effective for claims received on or after November 16, 2016, providers should provide sufficient information in the REMARKS field (FISS Page 04) that clearly indicates all the circumstances and time frames supporting the exception request .  If the information in the REMARKS field is not clear, CGS will request additional documentation.  If documentation is requested, the preferred method for submitting exception request documentation to CGS is via FAX (1.615.660.5982); however, CGS will also accept documentation via US Mail, or esMD. FISS Claim Page 08, which is available while the claim is in status/location S B6001, provides detailed information for submitting your documentation for exceptional circumstances. For additional information about requesting an exception, refer to the "Requesting an Exception for an Untimely NOE" Web page.

     Reviewed: 03.16.17

6. What is the anticipated time for CGS to review the exception documentation submitted in response to the non-medical ADR?

   • CGS has 60 days to review the documentation submitted in response to the non-MR ADR request. However, documentation may be reviewed sooner than that. Documentation will be reviewed on a first come, first served basis. We encourage you to submit documentation as soon as possible.

     Reviewed: 03.16.17

7. Would issues with sequential billing be a valid exceptional circumstance for late filing of an NOE? For example, if hospice #2 determines that hospice #1 has not terminated the prior hospice benefit period, should hospice #2 go ahead and file the NOE, knowing they may need to back it out later to allow hospice #1 to complete their billing? In these cases, can an exception be requested by hospice #2 since they had to back out their NOE?

   • Sequential billing circumstances may be a valid exception request. If hospice #2 determines that a termination/revocation has not yet been posted by the prior hospice (hospice #1), hospice #2 should submit their NOE within the required 5-days. Hospice #2 may also want to contact hospice #1 regarding the open benefit period. If hospice #2's NOE does not process because of the open benefit period, or if the NOE processes and must later be canceled to allow hospice #1 to bill, this could be a valid exceptional circumstance. In these cases, the hospice (hospice #2) would need documentation supporting the timely submission of the NOE, and, if appropriate, documentation to support the need to cancel the NOE to allow the prior hospice to bill.

     Reviewed: 03.16.17

Notice of Termination/Revocation (NOTR) Questions

1. Should a hospice submit an NOTR if the final claim is not ready to be submitted due to pending drug reporting information?

   • Yes, per CR 8877, a hospice should submit an NOTR within 5 calendar days after the live discharge/revocation. After the NOTR has processed, and drug information has been obtained for reporting purposes, the hospice claim can be submitted.

     Reviewed: 03.16.17

2. Will the submission of an 8XB (NOTR) prohibit a final claim from being submitted/processed at a later date?

   • The filing of an NOTR will not prevent a final claim from processing, assuming that the dates on the final claim are not beyond the termination/revocation date indicated on the NOTR.

     Reviewed: 03.16.17

3. What happens if an NOTR was submitted and processed, resulting in a posted revocation/discharge, and it is later determined that the revocation/discharge was incorrect, or overturned by the QIO via the expedited determination process? Will the hospice be able to continue to file claims or will the claims RTP?

   • If an NOTR is submitted in error, the hospice would need to cancel the benefit period (8XD) in which the termination/revocation was posted. Any processed claims that fall within the benefit period must be canceled before the 8XD is submitted. Refer to the "Canceling a Hospice Notice of Election or Benefit Period" webpage for additional information on how to cancel a benefit period.

     If the NOTR was submitted in error, and the benefit period being canceled removes the benefit period created by the NOE, a new NOE will have to be submitted. This NOE will be untimely, and likely not meet the circumstances to grant an exception.

     If the NOTR needs to be canceled due to an expedited determination decision by the QIC, this would be beyond the provider's control, and an exception may be granted in this case, assuming sufficient documentation is provided to support the request.

     Reviewed: 03.16.17

4. What is the consequence for not submitting a timely NOTR (within 5-days after a live discharge/revocation)?

   • There is no financial penalty for late filing of the NOTR, itself. However, submission of an NOTR within 5 days after discharge/revocation is a CMS requirement, and is necessary to ensure prompt updating of the beneficiary's eligibility record to ensure they have access to medical care. If a patient is readmitted to hospice, and the subsequent NOE RTPs due to an overlapping open hospice benefit period for the same agency, and the NOTR (or final claim) was not submitted timely, the exception request may not be granted.

     CGS may use data analysis to identify non-compliant providers. Providers who exhibit a pattern of non-compliance may be referred for education or further action.

     Reviewed: 03.16.17

5. The FROM and TO dates on the NOTR will likely span one month. Will the current claim editing that prevents claims from spanning one month be applied to the NOTRs?

   • No, the editing in place to ensure hospice claims are billed monthly does not apply to NOTRs.

     Reviewed: 03.16.17

6. What information must be reported on an NOTR (type of bill 81B or 82B)?

   • When submitting an NOTR, information must be entered on FISS Page 01 and Page 03. For information on the fields required and the data that must be entered, refer to the "Notice of Election Termination/Revocation (NOTRs) – 8XB" section of the Hospice Claims Filing webpage on the CGS Home Health and Hospice website. Remarks, indicating the reason for discharge, are not required, but may be entered on FISS Page 04.

     Reviewed: 03.16.17

7. What if the NOTR (8XB) is submitted in error, or submitted with an incorrect date? How do you correct an 81B?

   • When an NOTR is submitted in error, or includes the wrong date of discharge/revocation, it will post an incorrect termination date on the beneficiary's eligibility file. In these cases, the benefit period must be canceled to remove the incorrect termination date. To cancel a benefit period, refer to the "Canceling a Hospice Notice of Election or Benefit Period" webpage.

     Reviewed: 03.16.17

8. Does an NOTR (8XB) need to be submitted for a patient that dies?

   • The billing requirements in CR 8877 for submitting an NOTR only apply to live discharges. This includes patients who are discharged from the Medicare hospice benefit by the hospice agency, and beneficiary revocations. An NOTR should not be submitted when a patient is discharged due to death (patient status code 40, 41 or 42).

     Reviewed: 03.16.17

9. If a patient terminates or revokes, and we submit the 81B to close the cert period, do we still have 12 months after the TO date to file the claim?

   • Yes, the requirements in CR 8877 do not change the Federal Timely Filing Guidelines for submission of the claim. Hospices will still have one year, as of the TO date, to submit claims to Medicare.

     Reviewed: 03.16.17

10. Will a Notice of Termination/Revocation (NOTR) process if the discharge/revocation occurs during a benefit period that has not yet been established at the Common Working File (CWF)?

    • No. The NOTR will return to the provider (RTP) with a reason code indicating that the revocation/termination date does not match a benefit period posted to the CWF. In order for an NOTR to process, the benefit period in which the patient was discharged has to be established in the CWF. For example, if the beneficiary revokes or is discharged on November 2nd, but the current benefit period posted in the CWF ends on October 27th, the claim for the October billing period must be submitted to get the subsequent benefit period posted to the CWF before an NOTR will process.

      On November 26, 2014, CMS issued a message via the MLN Connects Provider eNews with the article "Hospice Notices Returned to Provider" to acknowledge this issue.

      As a reminder, the NOTR only has to be submitted if the final claim has not yet been submitted. If the final claim can be submitted as soon as the next benefit period has posted to CWF, the provider should submit the final claim, and the NOTR is not required. In the example above, the final claim for November 1st through November 2nd could be submitted as soon as the benefit period beginning October 28th is posted to CWF. If the claim cannot be submitted as soon as the October 28 benefit period has posted to CWF, the NOTR should be submitted.

      Reviewed: 03.16.17

Q5003/Q5004 Situations

1. How does the hospice provider know/verify if a facility is "solely certified" as a SNF?

   • Hospices who are unsure how a facility is licensed or certified should contact the facility to determine this. In addition, the hospice may also contact the State Survey Agency to determine how a facility is licensed or certified.

     Reviewed: 03.16.17

Diagnosis Codes

1. Effective for dates of service October 1, 2014, we understand that certain diagnosis codes will no longer be permitted as a primary diagnosis. Will there be editing to ensure the diagnosis codes on our claim match our NOE?

   • No, there is no editing to confirm the diagnoses reported on the NOE are the same as those submitted on the claim.

     Reviewed: 03.16.17

2. Do we need to change the diagnosis code on our NOEs that were submitted prior to October 1, 2014?

   • No, if an NOE was submitted for an admission prior to October 1, 2014, there is no need to go back and change the diagnosis that was reported on the NOE.

     Reviewed: 03.16.17

3. Attachment A includes the dementia ICD-9 code 294.20 which is an accepted diagnosis code. The CMS MLN Matters article MM8877 mentions ICD-9 code 294.10, but that code is not listed on CR 8877 Attachment A. Please clarify if both of these codes are unacceptable or if there is a typo.?

   • CR 8877 specifies that ICD-9 codes 294.10 and 294.11 are included in the existing Medicare Code Editor edits, which prohibits these diagnoses as the principal diagnosis. The diagnosis codes listed in Attachment A are new edits that will be implemented as a part of CR 8877. As a result, both 294.10 and 294.20 will be prohibited as a principal diagnosis.

     The ICD-10 Version of the Medicare Code Editor is available on the CMS website. Scroll down to the Downloads section of the Web page to access the "Definition of Medicare Code Edits v33" zip file.

     Reviewed: 03.16.17