CMS Update

CMS Releases Notice Regarding Late Hospice NOEs

On December 1, 2016, CMS released a MLN Matters article addressing timely filing of Notice of Election (NOE) for hospice.

Hospices must file an NOE for each patient within five calendar days after the effective date of the election. If an NOE is not submitted and accepted within this time period, Medicare will not cover and pay for hospice care form the effective date of election to the date of filing the accepted NOE.

However, CMS has determined that timely-filed NOEs with unintentional errors that cannot be corrected while the NOE is in process due to Medicare system constraints outside of the hospice’s control should qualify for an exception to the timely filing requirement.

MACs have been instructed to grant an exception for a late NOE if the hospice can provide the MAC the following documentation and if the hospice took action to make the correction within two business days:

  1. When the original NOE was submitted
  2. When the NOE was returned to the hospice for correction or was accepted and available for correction, and
  3. When the hospice resubmitted the NOE.

Once the NOE is returned for correction, the hospice has two business days to resubmit. If an NOE was posted to the Common Working File (CWF) and has to be canceled and resubmitted, the hospice will have two business days to cancel the NOE and then two additional business days to resubmit the new NOE after the date the cancellation NOE finalizes.

If the hospice provides adequate information in the “Remarks” section of its claim that allows the MAC to research the case, then MACS can make a determination without requesting the additional supporting documentation described above.

Please note that MACs will grant an exception ONLY for instances where timely-filed NOEs had errors that could not be immediately corrected due to system constraints. Additionally, this exception is applicable for claims submitted on or after November 16, 2016.

For more detailed information on this notice, click here.

Struggling to manage your NOEs? HEALTHCAREfirst can help! Contact us to learn more about NOE Tracker.

 

December 8, 2016

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