Late Medicare Hospice NOEs—Additional Exceptions to Be Granted

Thoughtware Article Published: Jan 01, 2017
Performance Improvement

In 2014, the Centers for Medicare & Medicaid Services (CMS) implemented Change Request 8877, requiring hospices to submit an electronic Notice of Election (NOE) within five days following the Medicare hospice admission date or risk denial of payment for all days of service prior to the receipt and acceptance date of the NOE by the Medicare Administrative Contractor (MAC). Once the NOE is entered in the CMS Direct Data Entry (DDE) system, some errors will cause it to immediately be returned for correction. Other errors aren’t immediately recognized within DDE, and the NOE must be fully processed before the hospice can correct and resubmit it, which often takes multiple days. Since the implementation of this five-day submission requirement, the error rate when submitting NOEs has contributed to hospice payment denials.

On December 1, 2016, CMS issued Medical Learning Network Matters SE1633. Effective for claims submitted on or after November 16, 2016, MACs have been instructed to grant exceptions to the five-day rule if a timely filed NOE contained an error that couldn’t be corrected while it was in process. Errors that can’t immediately be corrected due to DDE system constraints are outside the hospice’s control and now qualify for an exception to the timely filing requirement.

MACs now will grant an exception for a late NOE if the hospice can provide documentation showing:

  • When the original NOE was submitted
  • When the NOE was returned to the hospice for correction or was accepted and available for correction
  • When the hospice resubmitted the NOE

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

If the hospice provides sufficient information in the remarks section of its claim related to the late NOE, allowing the MAC to research the case, then the MAC will make a determination without requesting additional supporting documentation. If a MAC does request additional documentation, it should consist of DDE screen images or any Medicare systems printouts that contain the above supporting information.

MACs only will grant an exception for instances where timely filed NOEs contained errors that couldn’t immediately be corrected due to system constraints. An exception may be granted in these situations:

  • NOE contains an error that cannot be corrected while the NOE is in process
  • NOE contains an error not detectable by edits in the CWF, such as an incorrect admission date
  • Rare instances of CMS “dark days” affecting the NOE receipt date recognized by the MAC

Errors that won’t be applicable for a late exception because the DDE system can detect them and cause the submission to return to provider for correction include:

  • Invalid marital status
  • Invalid/missing from date
  • Invalid Medicare number
  • Invalid/missing payor code
  • Invalid/missing occurrence code 27
  • Invalid National Provider Identifier (NPI)
  • Invalid type of bill
  • Beneficiary’s name/Medicare number mismatch
  • NOE falls within an established hospice benefit period

Other errors that won’t be applicable for a late exception:

  • Submission of a partial NOE
  • For hospices with multiple provider identifiers, submission of an NOE with the NPI of a location that didn’t provide the service

These new exception circumstances could offer relief for hospices that have been challenged to consistently comply with the five-day timely filing requirement for NOEs.

For additional information, refer to the Change Request or contact your BKD advisor.

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