Eli's Hospice Insider

Published on Wed Aug 17, 2016 PDF

The New Year holds good news for one billing hang-up.

Erroneous claim rejections for late NOEs should be eliminated by a new condition code to use to identify when an occurrence span code 77 period is caused by a late recertification of the terminal illness.

Old way: Currently, hospices use OSC code 77 to indicate both when orders are not received timely and when a Notice of Election is not filed timely, the Centers for Medicare & Medicaid Services explains in CR 9590 at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3577CP.pdf. The system can’t tell the difference between the two reasons, so claims reject in error when code 27 (indicating the hospice certification date) happens during the OSC code 77 time period.

New way: Starting Jan. 1, hospices can use OSC code 85 to indicate the late certification. For that code, the system will not allow code 27 to occur during that time span. For code 77, a code 27 in the time span will no longer make the claim reject. “An occurrence code 27 date within the OSC span dates in the case of an untimely NOE is perfectly appropriate,” CMS notes in the transmittal.