MedLearn Matters Special Edition Advises on Hospice-related Services

Change Request 8923 – corrects the current notation (remittance advice remark code N211) indicating that when the Medicare Administrative Contractor (MAC) determines that a hospice is not eligible for an exception to the Notice of Election timely filing requirement, the decision is not appealable.

In fact, the decision IS appealable and CR8923 corrects the error.  The implementation date for this change is April 6, 2015.

Following is a brief excerpt from the CR: If the request for an exception is approved by the Medicare contractor, the Medicare contractor processes the claim with a CWF override code and removes the submitted provider liable days, which will allow payment for the days associated with the late-filed NOE. If the Medicare contractor finds that the documentation does not support allowing an exceptional circumstance, the Medicare contractor shall process the claim as submitted. Due to a system limitation, the provider liable days on these claims currently receive remittance advice remark code N211 (Alert: You may not appeal this decision) in error. The exception request decisions are appealable. The purpose of this CR is to correct this error.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2014-Transmittals-Items/R3118CP.html?DLPage=2&DLSort=1&DLSortDir=descending

The CR also makes some minor clarifications relative to proper billing of non-reimbursable services and changes for the non-covered days associated with the NOE that is not filed timely.

A second document that CMS has posted is a REVISED Medlearn Matters article (SE 1321 REVISED) “Hospice Related Services – Part B”.  The article addresses billing of Part B services for hospice-enrolled beneficiaries, including guidance on the proper modifiers that should be used.  CMS has modified the article to clarify certain references, including changing any references to “hospice diagnosis” to “hospice prognosis”.  Following is a link to an article that NAHC published in conjunction with the initial posting of SE 1321:  http://www.nahc.org/NAHCReport/nr130722_1/

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