myCGS

Eligibility

Hospice/Home Health

The Home Health Care section provides information for each episode start and end date and the corresponding billing activity dates.

The Hospice section provides eligibility information when the hospice benefit is effective and when it terminates, in addition to the total hospice occurrence count for the listed beneficiary.

If the patient has any gap in their episode of care or changes providers at any time, or if their hospice provider has sent the final claim revoking hospice care, you will see more than just a single effective date being returned. Once the final claim has been submitted, the hospice termination (or revocation) date is returned, along with the revocation code. If the patient is still in hospice care, but has changed providers, the start and termination date with each provider will be returned. Therefore, if no termination date is returned, it is to be assumed that the patient is still under hospice care, as no claim has yet been processed that revokes that period of care.

NOTE: The "Hospice/Home Health" sub-tab displays hospice and/or home health data and will not be accessible when there have been no claims received by CMS indicating hospice or home health coverage is active and is in effect per the date(s) requested. To make sure you see all the information, enter a date range in the inquiry screen.

Screenshot

The tables below describe the "Home Health/Hospice" sub-tab fields:

Home Health Care

Field Name Description

Patient Status

Notes whether the patient is actively receiving services

NOA Indicator

Starting January 1, 2022, Medicare requires Home Health Agencies (HHAs) to submit a one-time Notice of Admission (NOA) instead of Requests for Anticipated Payment (RAPs). myCGS displays:

  • NOA received without condition code 47
  • NOA received with condition code 47

HHEH Start Date

The date the 60-day home health episode period started

HHEH End Date

The date that the home health episode terminated

HHEH DOEBA Date

The date of earliest billing activity for spell of illness

HHEH DOLBA Date

The date of latest billing activity for spell of illness

Provider Number

The NPI of the home health facility

Provider Number Type

A display of "NPI" depending on the source of the provider number

Contractor Number

A display of the Medicare contractor number

Contractor Name

The name of the Medicare contractor

HH Certification Start Date

The date the beneficiary was certified to receive home health care services

HH Recertification Start Date

The date the beneficiary was recertified to continue receiving home health care services

Hospice

Field Name Description

Effective Date

The start date of a beneficiary's elected period of hospice coverage

Term Date

The termination date of a beneficiary's elected period of hospice coverage. No date in this field means the beneficiary's elected period of hospice coverage has not terminated.

Start Date (DOEBA)

Date of Earliest Billing Activity

End Date (DOLBA)

Date of Latest Billing Activity

Days Used

The number of Hospice days used

Provider Number

The NPI of the hospice facility

Type

A display of "NPI" as the type of provider number

Notices of Election (NOE)

The Notice of Election (NOE) is to be submitted within 5 days after a hospice admission in order to be considered timely.

  • The election receipt date, NPI, and revocation code are listed here, if applicable.

Revocation Code

The code indicating the revocation status for the spell listed

Medicare Beneficiary in Hospice Care
0 - Not revoked, open spell

Medicare Beneficiary with Hospice Care Revoked
1 - Revoked by notice of revocation
2 - Revoked by notice of revocation with a non-payment code of "N" and an occurrence code of "42"
3 - Revoked by a hospice claim with an occurrence code of "23"

Election Revocation Date

The date the spell revoked

myCGS will display up to 50 billed Hospice episodes that occurred in the last four years.

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