Hospice Election Periods and Benefit Periods in Medicare Systems

20.1.6 Hospice Election Periods and Benefit Periods in Medicare Systems (Rev. 4280, Issued: 04-19-2019, Effective: 07-21-19, Implementation: 07-21-19) Election Periods An election period as described in CFR § 418.21 is the initial 90-day period, subsequent 90-day period; or an unlimited number of subsequent 60-day periods. In the Medicare systems the term ‘election period’ is used to describe the overall period between an election and revocation, which may include multiple 90-day or 60-day periods. Medicare systems refer to the 90-day or 60-day periods as ‘benefit periods.’ Therefore, hospices should be aware that when they see references to ‘election periods’ in regulation or in the Medicare Benefit Policy Manual, they are referring to what is called a ‘benefit period’ for purposes of claims processing. Hospice election and revocation date information are stored in a separate election period in Medicare systems from benefit period information, so the two types of information can be changed independently. Both election periods and benefit periods are stored in Medicare’s Common Working File (CWF) and can be viewed via inquiry screens. When a hospice submits an NOE (TOB 8xA), Medicare systems create an election period. The election period file for each beneficiary contains the following data elements for each of their election periods: • Period Number – a sequential number assigned to each election period • Elect Date – the date of election reported in the From date of the NOE • Receipt Date – the receipt date of the NOE that created the election period • Revoc Date –the revocation date reported in the Through date of the NOTR or of a discharge claim • Revoc Ind – a revocation indicator assigned when the revocation date is recorded • Provider – the CMS Certification Number (CCN) of the hospice that submitted the NOE • NPI – the National Provider Identifier of the hospice that submitted the NOE. When an 8xA is processed, the election date and receipt date will be updated on the election period CWF inquiry screen. The revocation date remains blank and the revocation indicator is 0. The NOE receipt date will be retained on the election period permanently. If benefit periods are cancelled, this will not remove the NOE receipt date from Medicare systems. If the election date is changed using the occurrence code 56/condition code D0 process described above, the NOE receipt date will not change. When a hospice submits an NOTR (TOB 8xB), Medicare systems will post a revocation date on the election period and change the revocation indicator to 1. Similarly, if a revocation date is corrected using the 56/D0 process, the correct date will be displayed on the election period. If the hospice files the discharge claim in lieu of the NOTR, the claim will also post the revocation date and revocation indicator on the election period, in addition to updating the Term Date1 of the benefit period to match the revocation date. A later NOE for the same beneficiary when there is no revocation date on the election period will be rejected. Consistent submission of revocations, via NOTRs or claims, within 5 days of the revocation date as required by regulation, is very important to prevent this. When a hospice submits a Change of Provider/Transfer Notice (TOB 8xC) or a Change of Ownership Notice (TOB 8xE), this will make no changes to the election period. Benefit Periods The hospice benefit period file pre-existed the episode period file and retains all the same fields it had historically, but election-related fields on those screens will no longer be used. The hospice benefit period file for each beneficiary contains the following data elements for each of the benefit periods they use while receiving hospice care: • Start Date1 – the start date of the benefit period • Term Date1 -- the end date of the benefit period • Prov1 -- the CCN of the hospice whose claim created the benefit period • Inter1—a number identifying the Medicare Administrative Contractor serving Prov1 • DOEBA Date – date of earliest billing activity, the first date billed in the period • DOLBA Date – date of latest billing activity, the Through date of the last claim processed in the period. • Days Used – the number of days in the period used to date • Start Date2 – the effective dates of a transfer during the period • Prov2 -- the CCN of the hospice from the 8xC transfer notice. • Inter2 -- a number identifying the Medicare Administrative Contractor serving Prov1 • Revocation Ind – no longer used. Benefit period contain two columns of information. One captures information on the original billing hospice and any hospice receiving a transfer. A second column, labelled “Owner Change” captures information about a change of ownership to either of these hospices. Benefit periods are created by submitting claims. Benefit period information supports claims processing functions only, while the election period carries only the beneficiary’s election status. If a hospice needs to cancel all the claims in a benefit period, Medicare systems will remove the hospice benefit period. The first claim submitted by the hospice after an election must ensure the From and Admission dates match the election period start date. This will ensure the first benefit period in the election is created correctly and subsequent claims will process. When a hospice submits a Change of Provider/Transfer Notice (TOB 8xC) or a Change of Ownership Notice (TOB 8xE), this will post the Start Date2 and Prov2 information on the hospice benefit period. When a hospice submits a Change of Ownership Notice (TOB 8xE), this will post an Owner Change start date on the benefit period. Summary Chart The following chart provides a reference to help hospices understand which of their submissions will impact an election period or a benefit period. Effects of Election Periods Effects of Benefits Periods Transaction Type Type of Bill Creates Election Period Changes Existing Election Period Removes Election Period Creates Benefit Period Changes Existing Benefit Period Notice of Election Period 8xA Always OC 56 only Never Never Never Notice of Termination/Revocation 8xB Never Always Never Never Makes Term Date match revocation date Transfer Notice 8xC Never Never Never Only when no claims have created periods for previous hospice Always Void/Cancel of Election 8xD Never Never Always Never Never Change of Ownership Notice 8xE Never Never Never Only when no claims have created Always Effects of Election Periods Effects of Benefits Periods Transaction Type Type of Bill Creates Election Period Changes Existing Election Period Removes Election Period Creates Benefit Period Changes Existing Benefit Period periods for previous hospice Admit thru Discharge Claim 8x1 Never Adds revocation date and rev ind., if not a transfer Never Always Always Admission Claim 8x2 Never Never Never Always Always Continuing Claim 8x3 Never Never Never If OC 27 is present and “Through” date spans end of current period Always Discharge Claim 8x4 Never Adds revocation date and rev ind., If not a transfer Never If OC 27 is present and “Through” date spans end of current period Always