June 16, 2016

New Hospice Notice of Election Claim Edit to Be Implemented

Bonny Kohr, Senior Manager, Advisory Services

New Hospice Notice of Election Claim Edit to Be Implemented

Beginning October 3, 2016, Hospice Notices of Election (NOEs) submitted to the Medicare Administrative Contractor (MAC) without a principal diagnosis will not be processed and will be returned to the provider. Currently, there is no edit in place which requires the reporting of the principle diagnosis on the NOE’s, and the MAC’s have reported a high percentage of NOE’s submitted without a principal diagnosis. Change Request (CR) 9575 was issued on April 28, 2016, and is effective for NOE’s with dates of service on or after January 1, 2016. The CR requires the MAC’s to create an edit which prevents acceptance of NOE’s when there is no principal diagnosis present.

To avoid issues with late filing of NOE’s which must be accepted by the MAC within 5 calendar days after hospice admission, agencies should assess their current process for NOE submissions. Hospice agencies must ensure that the principal diagnosis has been assigned a code which is compliant with the Official Guidelines for Coding and Reporting and that the code is included on the NOE.

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Healthcare