Home Health & Hospice Week

You’d better get speedier on your hospice billing for patients who revoke, or you could cost yourself money.

Scenario: In a recent question-and-answer set, HHH Medicare Administrative Contractor Palmetto GBA had no sympathy for a hospice whose patient revoked the benefit on Sept. 25 and was readmitted Oct. 14. The hospice tried to submit the Notice of Election for the patient on Oct. 16, but it was blocked because the hospice hadn’t submitted the Notice of Termination/Revocation or a final claim for the patient. The hospice did eventually submit the final claim for the first submission on Oct. 21, and resubmitted an NOE successfully on Oct. 30 that was accepted Nov. 5.

When the hospice submitted its claim for Oct. 15-31, the claim was denied for lack of timely NOE. Then the hospice lost appeals at the MAC and QIC levels.

“The final claim was submitted on October 21, 2014, 25 days from the revocation date,” Palmetto says. “If for any reason the provider could not submit the final claim, a NOTR (8XB) could have been submitted any time after the revocation and would have prevented the NOE’s RTP.” Palmetto went on to chastise the hospice:

“In addition, by not revoking the election sooner, it is possible that the hospice may have affected other healthcare provider’s billings, reimbursement and the beneficiary’s access to healthcare services.”