CMS Updates Hospice Claims Processing Instructions – Corridor Group

Posted on Monday, November 9, 2020

CMS has changed the hospice portion of the Medicare Claims Billing Process Manual, updating the billing and processing.  This Change Request (CR) 12026 clarifies that for the Notice of Termination/Revocation (NOTR) to be accepted into the system, an election period must be established. If the notice of election, which creates the hospice election period, is not submitted and posted before the NOTR, the NOTR will be rejected.

The CR also:

  • “Adds the most used discharge codes for hospice claims,
  • Clarifies that occurrence code 42 is not required on the NOTR, since the through date represents the revocation date. Occurrence codes are only necessary on NOTRs when carrying the original revocation date on a correction.
  • Instructs the Durable Medical Equipment (DME) MACs on the handling of DME claims or a period when there is an open Medicare hospice election.   Specifically, CMS added that “DME MACs shall make determinations of relatedness in the same way the A/B MACs Part B do today – based entirely on the presence of the GW modifier and not based on diagnosis coding. If the claim exceeds the number of allowable modifiers, the DME MAC shall instruct the supplier to use modifier 99 on the line to indicate additional modifiers are reported in the remarks field. The supplier must include the GW modifier in the claim remarks. Claims that do not contain the GW modifier shall be denied.””

Source: NAHC Report


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