Cancellation of an Election

20.1.4 – Cancellation of an Election (Rev. 12847; Issued: 09-13-24; Effective: 06-03-24; Implementation: 10-07-24) A cancellation notice is used when the beneficiary will not be receiving services from the hospice, but the admission date has already been entered. The entered dates will be voided since the beneficiary never participated with the hospice. A cancellation notice removes the hospice election period that was created by an NOE. Cancellation notices are not needed to remove hospice benefit periods, which are automatically removed when all claims in the benefit period are cancelled. See section 20.1.6. Cancellation notices can also be used to remove a transfer or a change of ownership that was submitted in error. Type of Bill Enter the appropriate 3-digit numeric type of bill code, according to the following code structure: 81D - Hospice (Non-hospital Based) Void/Cancel hospice election 82D - Hospice (Hospital Based) Void/Cancel hospice election Statement Covers Period (From-Through) When there is no change in the provider number during the election, the hospice enters the election date of the election period that is being canceled. No through date is required. Any claims processed during the election must be cancelled before an election period can be removed. When there has been a transfer or change of ownership, the From date on the 8xD must match the corresponding transfer or change date to ensure those dates are removed correctly. 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 Show the month, day, and year numerically as MM-DD-YY. When there has been a transfer or change of ownership, the admit date on the 8xD must match the corresponding transfer or change date to ensure those dates are removed correctly. 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. 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.