Home Health & Hospice Week

Learn the ropes of the new process for fixing erroneous notices.

The many changes that have occurred with Medicare’s Notices of Termination/Revocation may have you feeling confused, but a new educational tool can help.

HHH Medicare Administrative Contractor Palmetto GBA has issued a new job aid on NOTRs (TOB 8XB), and it includes some advice to make your use of them easier.

For example: The process has changed for removing an NOTR filed in error. “Previously, [the Centers for Medicare & Medicaid Services] had instructed providers that they could remove an NOTR that was filed in error by submitting a corrected NOTR using all zeros (000000) in the ‘THROUGH’ date field,” Palmetto explains in the job aid. “However, subsequent to the updates, CMS and the Medicare Administrative Contractors (MACs) learned that the process to remove an NOTR using the zeros in the ‘THROUGH’ date field did not work.”

Now, hospices wishing to remove the flawed NOTR must cancel a final claim — submitting one first, when necessary. If that doesn’t do the trick of removing the revocation date and indicator from the system, hospices must cancel all claims in the benefit period in which the NOTR ended the hospice election, Palmetto instructs. If that works, hospices must then resubmit those bills in sequential order.

If neither of those works, you’ll need to cancel the Notice of Election, thereby removing the entire election period from the system. You then must resubmit the NOE within two days and request an exception to late-NOE-filing penalties based on the system limitations, Palmetto directs.

Hopefully you won’t have to resort to canceling the NOE too often. “In most cases, the MACs have found that the NOE only has to be canceled if [the] start date of the benefit period in which the beneficiary/patient was discharged or revoked is the same as the hospice election date,” Palmetto says. Other advice offered in the job aid includes:

• You can submit an NOTR only when you have not submitted a final claim. “While it is preferred that you file a final claim instead of a NOTR, there are certain situations that that may still require the NOTR,” Palmetto acknowledges in the aid.
• When you submit an NOTR to change the discharge or revocation date, you must use code D0. “When D0 is entered on the claim, Occurrence Code 56 and date must also be submitted,” Palmetto instructs. “If both codes are not submitted on the NOTR, it will be returned to the provider.”
• The same goes for OC 56 — the system will return the claim if D0 isn’t also on the claim.
• Medicare must be the primary payor for all NOTRs.
• You don’t need to report an “Other Physician ID” NPI when the hospice physician is the attending and certifying physician, Palmetto says. In that case, “only the attending physician NPI is required to be reported,” according to the aid.
• “For EDI submissions, Medicare encourages hospices to submit batch transmissions with groups of NOTRs separate from batch transmissions with groups of claims,” Palmetto says. “This practice may reduce the risk that translator-level rejections related to NOTRs that, if they occur, could impact payments to the hospice.”

Note: More advice is in the new job aid at www.palmettogba.com — select “Jurisdiction M Home Health and Hospice MAC” from the right column, then choose “Job Aids” from the “Top Links” box and select the Jan. 8 entry from the list, “Notice of Termination/Revocation of Election (TOB 8XB) Job Aid.”