Canceling a Hospice Notice of Election

When a patient elects hospice, the hospice submits a NOE to the MAC to notify the MAC and all other providers that the patient is now utilizing the Medicare hospice benefit for all services related to the patient’s terminal diagnosis. Once the NOE is processed, the hospice election remains open on the CWF until the hospice notifies Medicare of the discharge, revocation, or death.

The NOE should be filed as soon as possible after a patient elects the hospice benefit. By submitting the NOE timely, other providers will see that the patient is in the Medicare hospice benefit. This helps to prevent inappropriate Medicare payments to nonhospice providers for services related to the hospice diagnosis, and can prevent inappropriate payments to other hospices.

Situations When the NOE Must Be Canceled

Although rare, there are times when an NOE must be canceled. When a hospice election is established out of order, the NOE must be canceled. For example, a patient was with Hospice ABC from June through July. In October, the patient elects the hospice benefit with Hospice XYZ. Hospice XYZ checks the CWF and does not see a previous election. Therefore, Hospice XYZ submits an NOE for the patient’s admission in October. Later that month, Hospice ABC contacts Hospice XYZ to cancel their NOE so that Hospice ABC can submit their NOE and claims for the patient’s June through July services.

Situations When You Do Not Need to Cancel the NOE

If an error occurs in the primary diagnosis code, you do not have to cancel the NOE. The appropriate action is to submit the claim with the correct diagnosis code. If the primary diagnosis code is invalid, the system will return the claim to the provider. The provider will need to make the necessary corrections and resubmit the NOE.

The primary diagnosis can change throughout the hospice election. There is no need to resubmit a new NOE when the diagnosis changes. You can update the diagnosis on the claim when it is submitted.

If an incorrect attending physician NPI is entered on the NOE, the NOE does not need to be cancelled and resubmitted. The correct attending physician NPI will need to put on the claim.

If a beneficiary has not selected an attending physician at the time of the NOE submission, it is acceptable to enter the NPI of the hospice medical director. If the beneficiary elects an attending and the physician declines to be the attending physician, and the NOE has already been submitted with the selected attending physician NPI there is no need to cancel or change the NOE. When filing the claim, make sure the correct attending physician NPI is on the claim. Also, in the event the beneficiary selects another attending physician after the submission of the NOE, you do NOT need to cancel the NOE. When submitting the claim, put the corrected physician NPI on the claim.

Note: The primary diagnosis can change throughout the hospice election. However, if the primary diagnosis code submitted on the NOE was correct at the time the NOE was submitted, the NOE would not need to be canceled.

Steps to Cancel the NOE

Before canceling the NOE, the provider must cancel all processed claims (TOBs 8X1, 8X2, 8X3, 8X4) within the election. Once all claims are canceled, submit the notice of void/cancel (TOB 8XD) to remove the notice of election (TOB 8XA).

Do not submit TOB 8X8 or 8XB to remove the notice of election as these TOBs will not remove the election period from CWF.

Submitting the 8XD in FISS/DDE

Key 49 to access the INST Claim Entry Menu from the Claims and Attachments Entry Menu. Once in the claim entry screen, the following fields must be completed:

Claim Page One

Field	Description/Valid Values
MBI (Required)	Enter the beneficiary’s MBI
TOB (Required)	Enter the appropriate type of bill. Valid values are: 81D (Freestanding hospice) 82D (Hospital-based hospice)
Oscar (System)	The Medicare provider number (Provider Transaction Access Number [PTAN]) is system generated.
NPI (Required)	Enter the National Provider Identifier (NPI) associated with the OSCAR number.
STMT DATES FROM (Required)	Enter the start date of the hospice election period being canceled in the MMDDYY format
PATIENT DATA (Required)	Enter the beneficiary’s last name, first name, date of birth (MMDDCCYY), full mailing address, ZIP Code, and gender.
ADMIT DATE (Required)	Enter the start date of the hospice election period being canceled in the MMDDYY format. (Note that the ADMIT DATE and the STMT DATES FROM date should match.)
FAC. ZIP (Required)	Enter the facility ZIP code of the provider.

Claim Page Four

Field	Description/Valid Values
Remarks (Required)	Enter the reason that the election period is being canceled.