Eli's Hospice Insider

Published on Thu Apr 16, 2015 PDF

Tip: Pointing the finger at someone else won’t get you anywhere.

Not sure how to qualify for an exception to Medicare’s timely filing deadline for hospice Notices of Election? A new resource from one Medicare Administrative Contractor may help you master the exceptions process for the tight five-day timeline.

“Medicare guidelines allow for four exceptions if a hospice Notice of Election (NOE) is not filed timely,” CGS notes on its new web page, “Examples of Denied/Granted Exception Requests.” The MAC developed the page in response to a suggestion it received from its Hospice Advisory Group, it says in a message to providers.

Successful example: Most of the examples given are denials, but CGS offers a successful scenario involving a hospice whose patient had incorrect name information on file. After multiple unsuccessful attempts to submit the NOE, the hospice contacted CGS to update the patient’s file with the correct middle initial. “This circumstance was beyond the hospice’s control,” CGS notes.

Pointer: But the exception wasn’t automatic. CGS granted the exception “due to documentation and prompt submission of NOE once file updated,” the MAC says. “If the beneficiary file contains incorrect information, providing a screenprint of FISS Inquiry Option 10 and ELGH will help justify the exception request,” the MAC advises.

Unsuccessful examples CGS lists include multiple exceptions not granted when the NOE RTP’d due to a provider billing error (incorrect TOB, NPI, and other elements) and was resubmitted late. It also turned down a request when a billing clearinghouse submitted the NOE late.

Take a look at the nine examples at www.cgsmedicare.com/hhh/education/materials/examples_denied_granted_exceptions.html.