U5181

FISS Narrative 
Claim has been returned due to one of the following reasons:
  • Hospice claim will generate new hospice benefit period but 27 occurrence code (OC) is missing or invalid
  • 27 occurrence date is not within dates of service of claim. Claims will not set-up hospice benefit period. Therefore, 27 OC date is not needed on claim.
  • 27 occurrence code date is within 77 occurrence span code dates on claim. If re-certification did not occur prior to end of month, omit 27 occurrence code came from claim. If re-certification occurred prior to end of month, 27 OC date should be date of service following last date of non-coverage.

Explanation and Suggestion
Hospice agencies should use OC 27 and the date on all NOEs and initial claims following an election of the hospice benefit when certifications or recertifications are received ‘timely’ (by the end of the third calendar day).

  • The OC 27 and date cannot occur within the occurrence span code (OSC) 77 (non covered days, provider liability) dates
  • OC 27 does not alter or realign the start of the next benefit period in the Common Working File (CWF) when entered on the claim with OSC 77 (see below for instructions)
  • OC 27 and the date identify the beginning of an election period when entered on a claim that does not contain OSC 77

When the certification or recertification of the beneficiary’s terminal illness is not received on time, providers are required to enter OSC 77 (provider liability period) on the claim and the dates for which the certification was not received (not received by the end of the third calendar day). OSC 77 and the dates indicate the period of non-covered hospice care.

Note: There are circumstances when the OC 27 and date are identified on a claim to capture the 'actual date' a certification was obtained due to an untimely recertification (OSC 77). In this case, OC 27 does not alter or realign the start of the next benefit period in the CWF. You must verify the next benefit period/OC 27 date prior to billing the benefit period.

Verify the certification dates in DDE on the CWF (Pages two and three) under the hospice benefit periods. Ensure that your software is programmed in accordance with these specifications.

For further information please see the Billing Occurrence Code 27, Occurrence Span Code 77 and Late Recertifications Module.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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