Hospice Notice of Election

20.2.1.3- Hospice Notice of Election (Rev. 10437, Issued: 11-06-20, Effective: 10-01-20, Implementation: 12-09-20) Upon electing the Medicare hospice benefit, the beneficiary waives the right to Medicare payment for any Medicare services related to the terminal illness and related conditions (i.e., the patient’s prognosis) during a hospice election, except when provided by, or under arrangement by, the designated hospice or individual’s attending physician if he or she is not employed by the designated hospice (42 CFR 418.24 (d)). In order to establish the hospice election in the Medicare claims processing system, the hospice must submit a Notice of Election (NOE) as described in chapter 11, section 20.1.1 of the Medicare Claims Processing Manual (Pub.100-04). Prompt filing of the hospice NOE with the Medicare contractor is required to properly enforce this waiver and prevent inappropriate payments to non-hospice providers. The effective date of hospice election is the same as the hospice admission date. Timely-filed hospice NOEs shall be filed within 5 calendar days after the hospice admission date. A timely-filed NOE is one that is submitted to and accepted by the Medicare contractor within 5 calendar days after the hospice election. The practical meaning of ‘submitted to and accepted by the Medicare contractor’ is that the NOE was not returned to the provider for correction. Example: The date of hospice election is October 1st. A timely-filed NOE would be submitted and accepted by the Medicare contractor on or before October 6th. In instances where a NOE is not timely-filed, Medicare shall not cover and pay for the days of hospice care from the hospice admission date to the date the NOE is submitted to, and accepted by, the Medicare contractor. These days shall be provider liable, and the provider shall not bill the beneficiary for them. Example: The date of hospice election is October 1st. The NOE was not submitted and accepted by the Medicare contractor until October 10th. Provider liable days would be October 1st through October 9th. There may be some circumstances that may be beyond the control of the hospice where it may not be possible to timely-file the NOE within 5 calendar days after the effective date of election or timely-file the Notice of Termination or Revocation (NOTR) (see section 20.2.4 - Hospice Notice of Termination or Revocation) within 5 calendar days after the effective date of a beneficiary’s discharge or revocation. Therefore, the regulations do allow for exceptions. There are four circumstances that may qualify the hospice for an exception to the consequences of filing the NOE more than 5 calendar days after the effective date of election. These exceptional circumstances are as follows: 1. Fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate; 2. An event that produces a data filing problem due to a CMS or Medicare contractor systems issue that is beyond the control of the hospice; 3. A newly Medicare-certified hospice that is notified of certification after the Medicare certification date, or is awaiting its user ID from its Medicare contractor; or, 4. Other circumstances determined by CMS to be beyond the control of the hospice. If one of the four circumstances described above prevents a hospice from timely-filing its NOE, the hospice must document the circumstance to support a request for an exception, which would waive the consequences of filing the NOE late. Using that documentation, the hospice’s Medicare contractor will determine if a circumstance encountered by a hospice qualifies for an exception to the consequences for filing an NOE more than 5 calendar days after the effective date of election. If the request for an exception is denied, the Medicare contractor will retain the decision of the denial. Hospices retain their usual appeal rights on the claim for payment. A retroactive Medicare entitlement qualifies as one of the exceptions to a timely-filed NOE as this would be a circumstance that is beyond the hospice’s control. An individual must be entitled to Medicare Part A in order to be eligible to receive services under the Medicare hospice benefit and an individual who receives retroactive Medicare entitlement is entitled to Medicare hospice services effective on the first day of that entitlement. In the event of retroactive Medicare entitlement, the hospice would submit a request for an exception, which would waive the consequences of filing the NOE late. To receive an exception, the individual must meet eligibility requirements under the Medicare hospice benefit and must have elected to receive services under the Medicare hospice benefit. Therefore, the hospice must be able to provide the following documentation to Medicare contractors and/or CMS, if requested: (1) Proof of retroactive Medicare entitlement; (2) The certification of terminal illness that meets the criteria set forth in section 20.1; and (3) The hospice election statement that meets the criteria set forth in section 20.2.1.1. See Pub. 100-04, Medicare Claims Processing Manual, Chapter 11, “Processing Hospice Claims” for requirements for NOE submission, reporting provider-liable days, and qualifying circumstances for a request for exception.