Reason Code U5181

Description
Hospices use occurrence code (OC) 27 and the date on all notices of election (NOEs) and initial claims following a hospice election. OC 27 and the date are also required on all subsequent claims when the claim's dates of service overlap the first day of the next benefit period. When OC 27 is required, but not reported, or does not include the correct date, the NOE or claim will receive this reason code.

Resolution
Ensure OC 27 is submitted on all NOEs in field locator (FL) 31–34 of the CMS-1450 (UB-04) claim form. The OC 27 date must match the "From" date (FL 6) and "Admit” date (FL 12) on the NOE.

For example: The beneficiary elected the hospice benefit on December 4, 20YY. When submitting the NOE, the "From" date, "Admit” date and OC 27 date must all be 1204YY.
 

Ensure OC 27 is submitted on an initial claim (the first claim following a beneficiary's hospice election). The OC 27 date must match the "From" date and the "Admit” date on an initial claim.

• Example: The beneficiary elected the hospice benefit on December 4, 20YY. The initial claim's "From" and "To" dates are December 4 to December 31, 20YY. OC 27 and the date, 1204YY, are required on the claim.

Ensure OC 27 is submitted on subsequent claims when the claim's dates of service overlap the first day of the next benefit period. When the recertification is obtained timely (by the end of the third calendar date after the new benefit period starts), the OC date must be the first day of the new benefit period. (For untimely recertifications, see below.)

• Example: Using our previous scenario, the 1st day of the next benefit period is March 4, 20YY (90 days from December 4, 20YY). A claim with dates of service March 1 to March 31, 20YY, would require the OC 27 with the 0304YY date.

For untimely recertifications, the OC 27 date cannot fall within the occurrence span code (OSC) 77 dates. When a recertification is not obtained timely (by the end of the third calendar day), ensure OSC 77 is submitted on the claim in FL 35. The OC 27 and date must reflect the date the recertification was actually obtained; it cannot occur within the OSC 77 dates.

• Example: The new benefit period began on March 3, 20YY. However, the recertification was not obtained until March 8. As a result, OSC 77 is used to indicate the noncovered days 0303YY to 0307YY. The OC 27 date indicates the date the recertification was actually obtained: 0308YY.

 
Verify the correct OC 27 date; the majority of errors for U5181 occur because the date submitted with OC 27 is incorrect. The eligibility systems can be used to determine/verify the first day of the next hospice benefit period, and thus, the correct OC 27 date. The next benefit period begins one day after the "Term” date of the previous benefit period. This is the correct date to use with OC 27.

• Ensure OC 27 is submitted correctly. If OC 27 is required, but is missing from the NOE/claim, or the date associated with OC 27 is incorrect, the NOE/claim will be sent to your RTP file with reason code U5181