5CNER: The Election Statement Is Invalid
The services billed were not covered, as there was no valid signed election statement included with the documentation submitted for review.
How to Prevent This Denial
- A Medicare beneficiary must complete an election statement before the Hospice Medicare Benefit can begin. A beneficiary who meets the eligibility requirement in the Code of Federal Regulations 42 CFR — Part 418.20 may file an election statement with a particular hospice. The representative for this beneficiary may file the election statement if the beneficiary is physically or mentally incapacitated. The election statement must be signed no later than the first day for which the payment is claimed. It must also be signed if the beneficiary is reelecting the hospice Medicare benefit after a revocation or discharge from hospice.
- The provider must submit an election statement to the intermediary for every beneficiary who elects the Hospice Medicare Benefit. A beneficiary (or his/her representative) must elect hospice care to receive it. Once the decision to receive hospice care is made, an election statement must be filed with a particular hospice.
- All election statements must include the following information:
- Identification of the particular hospice which will provide care
- Acknowledgement the individual/representative has a full understanding of hospice, particularly the palliative vs. curative nature of treatment
- Acknowledgement that certain Medicare services are waived by the election
- Effective date of the election
- Individual’s designated attending physician (if any)
- Individual’s acknowledgement the designated attending physician is their choice
- Information on cost sharing/notification of the right to receive an election statement addendum/information on the BFCC-QIO, including the right to immediate advocacy
- Signature of the individual/representative
- The duration of the election statement will be considered to continue through the initial election period and through the subsequent election periods without a break in care as long as the beneficiary remains in the care of a hospice and does not revoke the election under the provision of Code of Federal Regulations, 42 CFR — Section 418.28
- When a Medicare beneficiary or authorized representative elects the hospice Medicare benefit, an election statement must be submitted to the Medicare Administrative Contractor (MAC) prior to the submission of the first bill