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.
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.
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:
Tips and Notes:
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:
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:
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.
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:
NAHC and HAA recommend that hospices:
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.