Medicare Compliance & Reimbursement

A claims system glitch has been returning numerous Notices of Election (NOE) to hospices in error, but a fix is on the horizon, indicates Medicare Administrative Contractor (MAC) guidance.

Problem: “NOEs submitted beginning 7/1/2019 are being RTP for the provider ZIP Code,” HHH MAC National Government Services says in an email to providers. “The reason code the NOEs are receiving is 32114. It has been determined the issue is in the Fiscal Intermediary Standard System (FISS).”

Normally NOEs aren’t edited for ZIP code, notes HHH MAC CGS on its website.

Solution: A fix is scheduled for Aug. 19, CGS says, meaning on Aug. 20 “NOEs submitted via EDI submission should process without editing for the ZIP code.” In the meantime, “providers may submit NOEs through DDE to avoid this issue,” HHH MAC Palmetto GBA says on its website.

Alternately, “Palmetto GBA will also process and allow late NOE exceptions for this specific issue,” the MAC says. “Agencies shall enter remarks on the exception request stating ‘NOE was incorrectly returned due to the ZIP Code issue with reason code 32114.’” If the agency submitted a new NOE via DDE due to the RTP and that NOE was late, “please include the claim number (DCN) for the EDI submitted NOE that was returned,” the MAC adds.

CGS also says it will allow late NOE exceptions for this reason with the same message. But “providers may correct their NOEs that are in RTP with reason code 32114 by entering the full 9-digit ZIP code,” also, the MAC offers.