Late Monday, August 4, the Centers for Medicare & Medicaid Services (CMS) issued a final rule governing hospice payment for fiscal year (FY) 2015: Medicare Program; FY 2015 Hospice Wage Index and Payment Rate Update; HospiceQuality Reporting Requirements and Process and Appeals for Part D Payment for Drugs for Beneficiaries Enrolled in Hospice. PLEASE NOTE: this link will no longer work after publication of the final rule in the Federal Register, which is scheduled for Friday, August 22.
The rule includes final payment rate information for the forthcoming federal fiscal year. It also finalizes some key hospice policy changes and reminds hospices that other, previously-announced changes will become effective on October 1, 2014. If hospices have not previously begun to prepare, they are advised to do so now.
- Imminent hospice policy changes addressed in the final regulation are as follows:
- Timeframes for Filing the Notice of Election (NOE) and Notice of Termination/Revocation (NOTR)
- Timeframe for Hospice Cap Determination and Overpayment Remittance
- Addition of the Attending Physician to the Hospice Election Form
- Coding Guidelines for Hospice Claims Reporting
- FY2015 Final Payment Rates
This article provides in-depth focus on policy changes related to timeframes for filing the NOE and NOTR. Future articles will address other forthcoming changes.
TIMEFRAMES FOR FILING THE NOTICE OF ELECTION (NOE)/NOTICE OF TERMINATION-REVOCATION (NOTR)
Previously CMS has not imposed a time frame for submission of a notice of election (NOE) other than directing hospices to submit the NOE as soon as possible. Similarly, there has been no requirement for filing of a Notice of Termination or Notice of Revocation (NOTR) and no explicit time frame for filing of a final hospice claim other than the existing one-year limit on claim submissions. However, in recent years, delays in submission of hospice NOEs and filing of final claims have led to inaccuracies related to patient status in the CMS systems.
These inaccuracies have been particularly problematic in efforts to ensure appropriate coordination of benefits for hospice patients with Part D prescription drug coverage. As a result, earlier this year CMS proposed that hospices submit an NOE and NOTR within 3 days of the patient’s election date or patient’s termination or discharge date, respectively. CMS finalized the rule with a timeframe of 5 days after the election date for filing of the NOE and 5 days after the termination/revocation date for the NOTR if the hospice has not filed a final claim.
Please note: As of this writing, CMS has not issued instructions to its Medicare Administrative Contractors (MACs) to implement the timeframes for filing of the NOE and NOTR. It is unclear whether or not CMS will be able to enforce the NOE and NOTR filing requirements effective October 1.
NOE FILING
Requirement: Effective October 1, 2014, hospices must file the NOE within five calendar days after the effective date of the election.
- Timely filing is considered having the NOE submitted and accepted by the Medicare Administrative Contractor (MAC).
- The date of election will count as day zero, so if a patient were admitted on a Thursday, the hospice must have the NOE filed, submitted and accepted no later than Tuesday.
Consequence: Hospices that do not submit the NOE in a timely manner cannot be reimbursed for any days of care prior to acceptance of the NOE by the MAC:
- The hospice cannot charge the beneficiary for hospice care during this time and must continue to provide hospice care to the beneficiary.
- CMS refers to these as ‘provider liable’ days.
Tips and Notes:
- The NOE must be filed by DDE, mail or courier.
- CMS did state they would look into the possibility of submitting the NOEs electronically but until then hospices must submit them via DDE, mail or courier.
- Hospices should ensure that they are able to get the NOE submitted via DDE and develop a back-up plan for mailing or delivering the NOE by courier to the MAC should the ability to submit it via DDE be interrupted and the situation does not meet one of the four exceptions.
- This may require a change in scheduling and staffing of personnel submitting the NOE. For instance, if the person(s) submitting the NOEs does not come into the office at least weekly, is on vacation, or unexpectedly not able to submit the NOE, another staff member will need to be trained to submit the NOE and verify that it has been accepted.
There are four circumstances that may be eligible for an exception to the timely filing requirement. The hospice must document the situation meeting the exception and request the exception.
Only if the MAC grants the exception are the consequences waived for the hospice. MACs will provide hospices with information about exceptions processes/policies in the future. The four situations CMS listed for exceptions are:
- Fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate;
- An event that produces a data filing problem due to a CMS or MAC systems issue beyond the control of the hospice;
- A newly Medicare-certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its MAC; or
- Other circumstances determined by CMS to be beyond the control of the hospice.
CMS stated in its comments that it will not allow exceptions for hospice personnel issues; internal IT systems issues that the hospice may experience; the hospice not knowing the requirements; and failure of the hospice to have back-up staff to file the NOE.
NAHC and HAA recommend that hospices:
- Add a compliance audit to their program that audits for the submission of the NOE within the required timeframe and process for documentation that the NOE has been accepted by the MAC;
- Modify processes and staffing as needed to ensure compliance;
- Develop a back-up submission plan;
- Modify policies and procedures to reflect this new requirement, its exceptions, and the hospice’s modified processes, and;
- Make every effort to submit and have the NOE accepted as soon as possible after election as CMS indicates it may consider shortening the five day requirement in the future.
NOTR (Notice of Termination/Revocation) FILING Requirement
Effective October 1, 2014 hospices must file the NOTR within five calendar days after the effective date of discharge or revocation, unless the hospice has submitted a final claim.
- Timely filing is considered having the NOTR submitted and accepted by the Medicare Administrative Contractor (MAC).
- The date of revocation or discharge will count as day zero so if a patient revoked on a Thursday, the hospice must have the NOTR filed (submitted and accepted) or a final claim submitted no later than Tuesday.
Consequence: CMS will not impose any consequences for late filing of the NOTR - or not having a final claim submitted - at this time but will consider doing so in the future. Late filing of the NOTR could negatively impact a beneficiary’s access to Medicare-covered items and services. It could also have negative consequences for any hospice provider taking the patient onto service following the termination or revocation.
Tips and Notes:
- CMS has not issued final instructions to the MACs to implement the NOTR requirement but it is likely that CMS will require use of bill type 81B as the NOTR.
- If this is the case, significant systems changes will be needed.
- Forthcoming instructions to the MACs will provide additional detail.
NAHC and HAA recommend that hospices:
- Add a compliance audit to their program that audits for the submission of the NOTR or the final claim within the required timeframe and process for documenting acceptance by the MAC;
- Modify processes and staffing as needed to ensure compliance
- Develop a back-up submission plan;
- Modify policies and procedures to reflect this new requirement and the hospice’s modified processes, and;
- Make every effort to submit and have the NOTR accepted as soon as possible after termination/revocation as CMS indicates it may consider shortening the five-day requirement in the future
NAHC has submitted several questions that have been raised by hospice providers specific to implementation of the NOE/NOTR requirements to the MACs and will provide responses and additional details as they become available.
Additional updates will be featured in future issues of NAHC Report and Hospice Notes.
