Change of Provider/Transfer Notice

20.1.3 - Change of Provider/Transfer Notice (Rev. 12847; Issued: 09-13-24; Effective: 06-03-24; Implementation: 10-07-24) If the beneficiary is transferred to another hospice (discharge status codes 50 or 51) the claim does not terminate the beneficiary’s current hospice benefit period. The admitting hospice submits a transfer notice after the transfer has occurred and the beneficiary’s hospice benefit is not affected. The 8XC does not get submitted until after the other provider has finalized their billing. NOTE: Transfers are not allowed from the same provider. Hospices must not submit an 8XC if the CMS Certification Number (CCN) is the same. In this scenario the beneficiary is not transferred to another hospice, they are transferred to another location of the same hospice. A beneficiary can change hospices only once per benefit period (90-day or 60-day). When the beneficiary transfers to a different hospice, he/she continues in the same benefit period. To transfer hospice programs, the individual or representative must file, with the hospice from which care has been received and with the newly designated hospice, a statement that includes the following information: (1) The name of the hospice from which the individual has received care and the name of the hospice from which he or she plans to receive care. (2) The date the change is to be effective. Given that hospices bill for the date of discharge or transfer, for claims purposes, the “From” date for the receiving hospice must be the same as the “Through” date for the transferring hospice, otherwise this would constitute a gap in care and a gap in billing and would not be considered a transfer. For example, if a beneficiary designates that a transfer is to be effective on January 10th, the transferring hospice’s “Through” date must be January 10th and the receiving hospice’s “From” date must be January 10th in order to be a continuous hospice election without a gap in care or billing. That is, the transferring hospice is responsible for the beneficiary up until, and including the transfer date. If the beneficiary is transferring from outside the service area and the transferring hospice cannot arrange care until the beneficiary reaches the new hospice, the hospice may discharge the beneficiary. This way, if the beneficiary requires medical treatment while in the process of transferring, he/she can access it under his/her traditional Medicare coverage. This would terminate the beneficiary’s current benefit period and require the beneficiary to re-elect hospice coverage at the new hospice and begin a new benefit period. The hospice transfer will be rejected if the transfer does not occur immediately. If the receiving hospice’s claim “from date” is not the same as the “through date” with "patient status” indicating a transfer (codes 50 or 51), the transfer will be rejected. The edit will not apply to a subsequent claim, if a transfer is posted and the hospice’s claim “from date” is the same as the “transfer date”. Type of Bill Enter the appropriate 3-digit numeric type of bill code, according to the following code structure: 81C - Hospice (Non-hospital Based) Change of provider 82C - Hospice (Hospital Based) Change of provider Statement Covers Period (From-Through) The “From” date would be the date the change is effective. No through date is required. Patient’s Name The patient’s name is shown with the surname first, first name, and middle initial, if any. Patient’s Address The patient’s full mailing address including street name and number, post office box number or RFD, city, State, and ZIP code. Patient’s Birth Date Show the month, day, and year of birth numerically as MM-DD-YYYY. Patient’s Sex Show an “M” for male or an “F” for female. This item is used in conjunction with diagnoses and surgical procedures to identify inconsistencies. Admission Date The hospice enters the admission date, which must be the start date of the benefit period in all cases except when a transfer occurs. In transfer situations, the receiving hospice should use their own admission date. When a new hospice admission occurs after a hospice revocation or discharge that resulted in termination of the hospice benefit, the new admission date cannot be the same as the revocation or discharge date of the previous benefit period. Show the month, day, and year numerically as MM-DD-YY. Condition Codes Condition codes are not required on an original transfer notice. If the hospice is correcting a date of transfer using occurrence code 56, the hospice reports condition code D0. If the two codes are not reported together, the transfer notice will be returned to the hospice. Occurrence Codes and Dates An occurrence code 27 is not required on a transfer notice, unless the date of transfer is also the first day of the next benefit period. Hospices may submit a transfer notice that corrects a date of transfer previously submitted in error. In this case, the hospice reports the correct effective date of the transfer in the From Date field and reports the original, incorrect effective date using occurrence code 56. Medicare systems use the original, incorrect date to find the benefit period to be corrected, then replaces that date of transfer with the corrected information. Release of Information Valid values are: I- Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes Y -Yes, provider has a signed statement permitting release of information. Provider Number The hospice enters their NPI. Insured’s Name Send all NOEs with Medicare as the primary payer. Enter the beneficiary’s name on line A. Show the name exactly as it appears on the beneficiary’s HI card. Insured’s Unique Identifier On the same lettered line (A, B, or C) that corresponds to the line on which Medicare payer information is shown enter the patient’s unique identifier by the health plan for the insured. For example, if Medicare is the primary payer, enter the MBI. To ensure accuracy and prevent a delay in the timely receipt or posting the hospice notice of election, hospices should validate this information using the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS). Only in the event that the HETS data is not available should the hospice show the number as it appears on the patient’s HI Card, Social Security Award Certificate, Utilization Notice, EOMB, Temporary Eligibility Notice, etc., or as reported by the SSO. Principal Diagnosis Code CMS accepts only HIPAA approved ICD-9-CM or ICD-10-CM/ICD-10-PCS codes, depending on the date of service. The official ICD-9-CM codes, which were updated annually through October 1, 2013, are posted at http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html The official annual updates to ICD-10-CM and ICD-10-PCS codes are posted at http://www.cms.gov/Medicare/Coding/ICD10/index.html Use full diagnosis codes including all applicable digits, up to five digits for ICD-9-CM and up to seven digits for ICD-10-CM. Attending Physician I.D. The hospice enters the name and provider identifier of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient’s medical care. The patient’s designated attending physician could be an independent physician, hospice physician, a nurse practitioner, or physician assistant. If there is no attending physician listed, then the hospice shall report the hospice certifying/recertifying physician. Other Physician I.D. The hospice enters the name and provider identifier of the hospice physician responsible for certifying/recertifying that the patient is terminally ill, with a life expectancy of 6 months or less if the disease runs its normal course. For electronic claims, this information is reported in Loop ID 2310F – Referring Provider Name. NOTE: Both the attending physician and other physician fields should be completed unless the patient’s designated attending physician is the same as the physician certifying/recertifying the terminal illness. When the attending physician is also the physician certifying/recertifying the terminal illness, only the attending physician field is required to be populated, the other physician field would not need to be populated. Provider Representative Signature and Date A hospice representative must make sure the required physician’s certification, and a signed hospice election statement are in the records before signing the Form CMS-1450. A stamped signature is acceptable.