Eli's Hospice Insider

Published on Tue Nov 20, 2018 PDF

Beware revocations that lead to lost reimbursement.

To make sure you don’t miss out on hospice payments that are rightfully yours due to Notice of Election delays, you should make sure you’re taking advantage of the Notice of Termination/Revocation ability.

Problem: “Why do Notice of Elections (NOEs) take so long to process?” one hospice provider asked HHH Medicare Administrative Contractor Palmetto GBA, according to a newly posted question-and-answer set from the MAC’s latest Ask The Contractor Teleconference. “This has been a problem when you have a patient who revocates frequently, causing the NOE to be untimely.”

Palmetto acknowledges that while “an NOE is not considered a Medicare claim and is not subject to many of the rules applied to claims, such as the 14 day waiting period for processing … the NOE must go through a series of edits.”

A more likely impediment to getting NOEs filed and accepted timely — thus receiving your full reimbursement — is that “with the conversion to election periods, a later NOE for the same beneficiary when there is no revocation date will be rejected with Fiscal Intermediary Shared System (FISS) reason code U5106,” Palmetto points out.

Hospices “sometimes deal with this issue when there is a revocation and subsequent readmission,” agrees billing expert M. Aaron Little with BKDin Springfield, Missouri.

Solution: “The quicker way of getting it resolved is to bill the NOTR, so that you can then bill a more timely NOE for the subsequent readmission,” Little advises.

“Consistent submission of revocations, via NOTRs or claims, within 5 days of the revocation date as required by regulation, will be increasingly important to prevent this edit,” Palmetto stresses in the ACT Q&A.

Palmetto offers more tips to avoid delayed NOEs for patients who revoke:

Hospices do not have to wait until the final claim or NOTR finalizes in location PB9997 before submitting an NOE for readmission. “Once the NOTR goes to location PB9996, the next billing can be submitted,” the MAC offers.

Allow NOTRs to be submitted at any time, rather than only when a benefit period covering the revocation date has been created by claims, Palmetto recommends.

Note: See the ACT summary and Q&As at www.palmettogba.com — click on “Jurisdiction M Home Health and Hospice MAC” in the right column, then choose “Learning and Education” under the pull down “Education/Events” tab in the top bar, then click on “Ask The Contractor Teleconferences,” then choose the Oct. 19 listing in the “Latest Articles” listing.