Instructions For Hospices: Notice of Election, Termination, Revocation

Members | September 01, 2014

The Centers for Medicare and Medicaid Services (CMS) released Change Request CR8877, which provides instruction to hospices and Medicare administrative contractors on processing the Notice of Election (NOE) and Notice of Termination or Revocation (NOTR). The change request includes important information on the exception process for NOEs and NOTRs that are not filed within 5 calendar days after the hospice admission date.

The Centers for Medicare and Medicaid Services (CMS) released Change Request CR8877, which provides instruction to hospices and Medicare administrative contractors on processing the Notice of Election (NOE) and Notice of Termination or Revocation (NOTR).

In the FY2015 Hospice Final Rule, the Notice of Election (NOE) must be filed by the hospice and accepted by the Medicare administrative contractor (MAC) within 5 calendar days after the hospice admission date.  

A timely-filed Notice of Termination or Revocation (NOTR) shall be filed by the hospice and accepted by the MAC within 5 calendar days after the hospice discharge/revocation date unless a final hospice claim has been filed. An NOTR does not need to be completed in cases where the patient is discharged due to death.

In cases when the NOE is not timely filed, a hospice is responsible to provide care and not charge the beneficiary for any days of hospice care from the hospice admission date to the date the NOE is submitted to, and accepted by, the Medicare contractor. Hospices will report these non-covered days on the claim with an occurrence span code 77, and charges related to the level of care for these days will be reported as non-covered, or the claim will be returned to the provider (RTP).  

There is currently no consequence to a hospice for not timely filing the NOTR.

There are four possible exceptions to the timely filing of an NOE:

  1. Fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate.
  2. An event that produces a data filing problem due to a CMS or Medicare contractor systems issue that is beyond the control of the hospice.
  3. A newly Medicare-certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its Medicare contractor.
  4. Other circumstances determined by the Medicare contractor or CMS to be beyond the control of the hospice.

Regardless of the reason a hospice is requesting an exception, the hospice shall file the associated claim with occurrence span code 77 used to identify the non-covered, provider liable days. The hospice shall also report a KX modifier with the Q HCPCS code reported on the earliest dated level of care line on the claim. 

The KX modifier shall prompt the Medicare contractor to request the documentation supporting the request for an exception. Based on that documentation, the Medicare contractor shall determine if a circumstance encountered by a hospice qualifies for an exception.

If the request for an exception is approved by the Medicare contractor, the Medicare contractor will process the claim with the CWF override code and remove the submitted provider liable days, which will allow payment for the days associated with the late-filed NOE. 

If the Medicare contractor finds that the documentation does not support allowing an exceptional circumstance, the Medicare contractor will process the claim as submitted. It is important to note that CMS has identified that due to a systems limitation, remittance advice remark code N211 (you may not appeal this decision) will be applied to the provider liable days in error. These days are appealable and CMS plans to release a correcting change request in the future.