Change of Ownership Notice

20.1.5 – Change of Ownership Notice (Rev. 12847; Issued: 09-13-24; Effective: 06-03-24; Implementation: 10-07-24) A change of ownership notice is used when the beneficiary will remain with the same hospice, but the person or group running the hospice is changing. A change of ownership typically occurs when a Medicare provider has been purchased (or leased) by another organization. Type of Bill Enter the appropriate 3-digit numeric type of bill code, according to the following code structure: 81E - Hospice (Non-hospital Based) Change of Ownership 82E - Hospice (Hospital Based) Change of Ownership 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. The date of admission may not precede the physician’s certification by more than 2 calendar days, and is the same as the certification date if the certification is not completed on time. EXAMPLE The hospice election date (admission) is 01/01/XX. The physician’s certification is dated 01/03/XX. The hospice date for coverage and billing is 01/01/XX. The first hospice benefit period ends 90 days from 01/01/XX. Show the month, day, and year numerically as MM-DD-YY. Condition Codes Condition codes are not required on an original change of ownership notice. If the hospice is correcting the effective date of a change 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 Hospices may submit a change of ownership notice that corrects the effective date of a change previously submitted in error. In this case, the hospice reports the correct effective date of the change of ownership 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 the effective date of the change of ownership 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. When a hospice agency changes ownership and a new Medicare provider number issued, the A/B Medicare Administrative Contractor (MAC) must be notified to update the provider number in the hospice period. This will avoid mistaking the change as a beneficiary-elected transfer. 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.