Notes from NAHC: CMS offers Solution to FISS and CWS Errors

NAHC reported that CMS has made modifications to the FISS and CWF systems to allow for  resubmission of NOEs when they contain errors.  We have received more detail and some clarification from CMS and have learned that hospices will now be able to immediately resubmit NOEs or NOTRs that contain BILLING errors.  This will allow hospices that discover that they have submitted a NOE or NOTR with an error that would cause it to RETURN TO PROVIDER (RTP) – i.e. errors that the FISS and CWF systems, through their edits, can detect as in conflict with other information in the system – to immediately resubmit the NOE or NOTR with the corrected information.

It is important to note that any error on a NOE or NOTR that would NOT otherwise be caught by the FISS or CWF edits cannot be corrected with a resubmission because the FISS and CWF systems will not detect a problem with the information and will automatically process those submissions.

Following is an article that we will be publishing in NAHC Report later today; we wanted to get it out to you as soon as possible so that you can begin to educate staff on this option in appropriate circumstances.

 CMS Allows for Resubmission of Some Hospice NOE/NOTRs with “Billing” Errors

Effective with implementation of Change Request (CR) 8877, hospices are required to submit a Notice of Election (NOE) for hospice patients admitted on or after October 1, 2014, within five days following the date of admission.  In instances where a hospice fails to file the NOE on a timely basis, payment will be denied for days of service prior to the Medicare Administrative Contractor’s (MAC’s) receipt and acceptance of the NOE.  Hospices are also required to submit a Notice of Termination/Revocation (NOTR) within five days following the date of live discharge, as well, but no penalty for late submission is being assessed at this time.

Since October, many hospices have failed to meet the NOE timely filing requirement because they have submitted NOEs that include errors.  To correct NOE billing errors, hospices have been required to wait for the NOE to be returned to provider (RTP), after which a new NOE could be submitted.  In many cases, the systems time required to process the RTP has meant that a replacement NOE could not be submitted and accepted in time for the hospice to be in compliance with the five-day rule.

In welcome news, two of the Centers for Medicare & Medicaid Services (CMS)’ MACs have reported that hospices that discover they have submitted an NOE with a systems-detectable billing error that will cause the NOE to RTP (such as an incorrect HICN) may now immediately submit a corrected NOE (rather than having to wait for the RTP to process).  The National Association for Home Care & Hospice (NAHC) has confirmed with CMS that this change is now in effect; CMS also indicated that hospices may immediately resubmit corrected NOTRs, as well, where submitted NOTRs included errors that would otherwise cause the NOTR to RTP.  This change will help to reduce the likelihood that systems processing time will result in lost revenue to hospices as the result of the NOE requirement.

HOSPICES MUST NOTE THAT THE ABILITY TO RESUBMIT A NOE OR NOTR THAT CONTAINS AN ERROR IS CONTINGENT ON THE ERROR BEING ONE THAT THE SYSTEM CAN DETECT AND THAT WOULD RESULT IN AN RTP if the NOE or NOTR is left to process through the system.  These errors are ones that the FISS or CWF system edits would detect as part of systems cross-checking.  Following are just a few examples of some common NOE and/or NOTR billing errors that could cause the submission to RTP:

 

  • Invalid marital status
  • Invalid/missing FROM date
  • Invalid HICN
  • Invalid/missing payer code
  • Occurrence code 27 required on NOEs
  • Invalid NPI – hospice agency or attending/certifying physician
  • Invalid type of bill – inconsistent with provider number
  • Beneficiary’s name/HIC don’t match
  • NOE falls within established hospice benefit periods

HOSPICES MUST ALSO NOTE THAT, In cases where an error on a NOE/NOTR is not detectable by edits in FISS or the CWF (such as an incorrect date of discharge on an NOTR) immediate resubmission will not work because the systems have no way to know whether the information that has been changed was incorrect.  In such cases the original NOE/NOTR will process through the system.  

Following are links to information posted by CGS and National Government Services (NGS), two of the Home Health/Hospice MACs, on the issue; as of this writing Palmetto GBA had not yet made any information on this issue public:

CGS

NAHC anticipates that the HHH MACs will be issuing additional information on this change and will be conducting education to assist providers in gaining greater understanding of this change.  NAHC will continue to report on this and related matters as additional information emerges.  Watch the NAHC Member Listserv and NAHC Report for further updates!