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Printed Date: 9/22/2015
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).
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.
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Last Updated: 01/11/2018