Hospice Notice of Election (NOE) Exception Examples
Published 08/28/2023
Timely-filed hospice Notice of Elections (NOEs) shall be filed within five calendar days after the hospice admission date. A timely-filed NOE is a NOE that is submitted to the Medicare contractor and accepted by the Medicare contractor within five calendar days after the hospice admission date.
If a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, the hospice shall submit a timely-filed Notice of Termination/Revocation (NOTR) unless the hospice has already filed a final claim. A timely-filed NOTR is a NOTR that is submitted to and accepted by the Medicare contractor within five calendar days after the effective date of discharge or revocation.
When the hospice did not file the NOE timely, it may request an exception. Below are examples of exceptions that Palmetto GBA has reviewed. When requesting an exception, providers are encouraged to enter detailed remarks which may include a time line. For specific directions on how to file an exception request, please see ‘Hospice Billing When a Notice of Election (NOE) was Filed Untimely’ Job Aid.
Examples of qualifying exceptions are as follows:
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Claim Inputs
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Overlap with Other Hospice Approved
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Admission Date
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4/7
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NOE Received
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4/14
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Occurrence Span Code
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77 with dates 4/7 to 4/13
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Provider Remarks
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We are requesting an exception for payment on this claim. Our 81A was originally submitted on 4/8 and went to RTP because of a previous provider that had not completed their billing. On 4/10, CWF had a revocation posted. We released our NOE from RTP, getting a new receipt date of 4/14.
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Conclusion
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The exception was approved. The provider entered remarks that clearly stated the issue of timeliness and resubmitted the NOE in a timely manner to avoid other potential issues after the previous hospice completed their billing. All information was verified by the contractor by reviewing the NOE’s audit trail and the other provider’s submission(s).
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Claim Inputs
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Newly Certified Hospice Approved
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|---|---|
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Admission Date
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10/08
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NOE Received
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10/14
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Occurrence Span Code
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77 with dates 10/08 to 10/13
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Provider Remarks
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We are a newly certified hospice and did not receive Direct Date Entry (DDE) access from MAC until 10/14. NOE keyed on 10/14.
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Conclusion
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The exception was approved. The provider entered remarks that clearly stated the agency was newly certified and provided the date they obtained DDE access, which is required to submit NOEs. All information was verified by the contractor by reviewing the agency’s enrollment information.
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Claim Inputs
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Readmission Approved
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|---|---|
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Admission Date
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3/11
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NOE Received
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3/18
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Occurrence Span Code
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77 with dates 3/11 to 3/17
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Provider Remarks
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Our 81A was previously submitted on 3/12 and went RTP because our NOTR, for the patient’s 3/9 discharge from our agency, had not processed.
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Conclusion
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The exception was approved. The NOTR for the 3/9 discharge and the NOE for the 3/11 admission were both received on 3/12. The hospice followed sequential billing and the 5 day billing election/revocation regulations. Therefore, the NOTR or final claim must be file on or before the date the readmission NOE is filed. Hospices can file an NOTR as early as the day after revocation/discharge (providers may not want to file on the date of discharge in case the patient returns later that day) to help eliminate late filing issues if there is a readmission at any time after a patient revokes or is discharged.
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Examples of non-qualifying exceptions are as follows:
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Claim Inputs
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Provider Issue Denied
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|---|---|
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Admission Date
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10/20
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NOE Received
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11/21
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Occurrence Span Code
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77 with dates 10/20 to 10/24 (service was only 4 days)
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Provider Remarks
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Please process this claim to pay. We have had some staff changes and this caused a delay in submitting the notice of election in a timely manner. We have created procedures to ensure this will not happen again.
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Conclusion
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The exception was denied. It was determined to not be beyond the hospice’s control.
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Claim Inputs
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Readmission Denied (1)
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|---|---|
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Admission Date
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5/6
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NOE Received
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5/18
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Occurrence Span Code
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77 with dates 5/6 to 5/17
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Provider Remarks
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Our 81A was originally submitted on 5/8 and went to RTP because of a previous provider that had not completed their billing. On 5/18, CWF had a revocation posted and we released our NOE from RTP getting a new receipt date of 5/20.
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Conclusion
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This exception was denied because the discharging hospice was the same as the admitting hospice and they did not file a discharge claim or Notice of Termination/Revocation of Election (NOTR) timely. The hospice must follow sequential billing and the 5 day billing election/revocation regulations. In this case, an NOTR could have been filed as early as the day after revocation/discharge (providers may not want to file on the date of discharge in case the patient returns later that day) since the benefit period was established at the CWF.
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Claim Inputs
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Readmission Denied (2)
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|---|---|
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Admission Date
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10/11
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NOE Received
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10/22
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Occurrence Span Code
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77 with dates 10/11 to 10/21
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Provider Remarks
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Our 81A was previously submitted on 10/15 and went RTP because our final claim was not submitted until 10/16, for the patient’s 10/9 discharge from our agency.
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Conclusion
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The exception was denied because the provider did not follow sequential billing and the 5-day billing election/revocation regulations. Neither the previous election discharge claim nor the NOTR was filed within five days of discharge . The hospice must follow the sequential billing regulations, and the 5-day billing election/revocation regulations.
The NOTR or final claim must be file on or before the date the readmission NOE is filed. Hospices can file an NOTR as early as the day after revocation/discharge (providers may not want to file on the date of discharge in case the patient returns later that day) to help eliminate late filing issues if there is a readmission at any time after a patient revokes or is discharged.
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Claim Inputs
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Provider Keying Error Denied
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|---|---|
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Admission Date
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5/4
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NOE Received
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5/21
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Occurrence Span Code
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77 with dates 5/13 to 5/20
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Provider Remarks
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Patient’s start of care was entered incorrectly on the NOE. It should have been 5/4, not 5/14. Original NOE was cancelled.
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Conclusion
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This exception was denied because it was a hospice billing error. To be accepted, the NOE/NOTR must be free of any billing/keying errors.
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