Home Health & Hospice Week

One MAC is using a workaround to let NOEs process via EDI - but the others aren't.

Hospices' may have to wait a bit longer for their full ability to reduce their exposure to reimbursement drains due to late Notices of Election.

A years-in-the-making solution to late NOEs was finally launched this month, as the Centers for Medicare & Medicaid Services began accepting electronic submission of the notice. CMS announced the process, which requires "a non-standard implementation of the 837I transaction" and supplementary trading partner agreements, last July and published its companion guide for NOE submissions last September (see Eli's HCW, Vol. XXVI, No. 34).

Before this process took effect this month, hospices had to submit NOEs either via paper or Direct Data Entry. But the new EDI process has come with its own set of problems.

Example #1: "The Companion Guide created by CMS included the use of the procedure code Q5009 (not otherwise specified code). This required a description in the service line (data element SV202-7); however, this information was not identified as being required in the Companion Guide," HHH Medicare Administrative Contractor CGS explains on its claims processing problems webpage.

"As a result, NOEs received without the procedure code description data element will reject in the EDI front-end editing and will be returned via the 277 Claims Acknowledgement Transaction."

CMS has revised the Companion Guide to include the missing data element, says the National Association for Home Care & Hospice in its member newsletter. "CMS has recommended that all hospices and vendors ensure that software being used to submit NOEs and related transactions include the description for Q5009 prior to submitting NOEs via EDI," NAHC advises.

See the updated guide at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Downloads/Companion-Guide-Electronic-Notices-Election.pdf.

Example #2: "When a hospice Notice of Election (NOE) is submitted via EDI ... the data included in the non-required Patient Status and Source fields is not being removed and is causing the NOE to suspend with reason code E2101," CGS explains on its website.

A fix to this issue is scheduled to be installed on Feb. 5, CGS reports. Meanwhile, hospices can submit NOEs via DDE. The MAC is also "exploring options for a work around to allow NOEs to process," it says.

MAC Palmetto GBA is also advising hospices to use DDE for NOEs, and hasn't announced any plans for a workaround, NAHC says.

MAC National Government Services, on the other hand, already has implemented a manual workaround allowing these NOEs to process, NAHC reports. That means "once a hospice has ensured that the software they are using includes the description that should accompany Q5009 ... they may submit electronically and should not be affected by the CWF edit," NAHC advises.

Watch your MAC for instructions specific to your area, the trade group recommends.

Note: CGS has added a number of NOE submission educational resources, developed in conjunction with other MACs, to its "Quick Resource Tools" website at www.cgsmedicare.com/hhh/education/materials/hospice_qrt.html.