Hospice Billing

Filing an Electronic Notice of Election (Type of Bill 8XA)

The NOE, TOB 8XA, is submitted when the hospice receives a signed election statement from the beneficiary acknowledging that he/she wishes to enroll in the Medicare hospice benefit. The NOE must be submitted to Medicare within five days of the date of election in order to be timely. Hospices can submit the NOE via the DDE system, EDI or hard copy (if applicable).

For EDI submissions, Medicare encourages hospices to submit batch transmissions with groups of NOEs separate from batch transmissions with groups of claims. This practice may reduce the risk that translator-level rejections related to NOEs, if they occur, that could impact payments to the hospice.

Hospices should note that NOEs submitted via EDI are subject to all front-end edits and may be rejected if all required data is not submitted or does not meet the required elements as outlined in the companion guide provided with CR10064. Electronically filed NOEs will receive a 999 acknowledgment within minutes of submission if accepted. Thus, hospices should also ensure that they monitor their acceptance reports (277CA and 999) at regular intervals. In addition, hospices should be aware that the NOE is subject to the batching process, which means it may be one to two days before the hospice will see the NOE in DDE if it was accepted. Once the NOE is accepted into FISS, processing time may vary as it is subject to all FISS and CWF edits. Therefore, providers are encouraged to also monitor the status of the NOE in DDE to ensure they make any corrections that may be necessary should the NOE be RTP for correction.

To complete the 8XA in DDE, select menu option ‘49’ from the claims entry menu. For submission of the NOE via EDI, follow your software instructions. The table below provides the fields that must be completed when submitting the NOE via DDE, EDI or hard copy (if applicable). Note: There are additional fields that will be required when submitting the NOE via EDI.

Field Descriptor DDE EDI **Hard Copy (UB-04 by Field Locator [FL]) Description/Valid Values
Provider Name, Address and Telephone Number X X X
(FL 1)		 The DDE system will auto-populate this information based on the NPI that is used for submission of the NOE.

For electronic submission through EDI, check with your software vendor to determine where this information is stored or if you will need to manually enter the information on the claim.
Type of Bill X
(TOB)
Claim Page 01		 X X
(FL 4)		 Enter the type of bill for the NOE. Valid values are:
  • 81A (Freestanding hospice: ‘81’ is system generated)
  • 82A (Hospital-based hospice: provider keyed)
Statement Covers Period (‘FROM’ Date) X
(STMT DATES FROM)
Claim Page 01		 X X
(FL 6)		 Enter the effective date of hospice enrollment in MMDDYY.

This date must match the admit date and the date reported with OC 27.
Statement Covers Period (‘THROUGH’ Date)   X   Enter the effective date of hospice enrollment in MMDDYY format. The date entered should match the date in the ‘from’ date field.
Patient’s Name X
(Last, First, MI) Claim Page 01		 X X
(FL 8)		 Enter the patient’s name as shown on the eligibility file with the surname first, first name and middle initial (optional), if any.
Patient’s Birth Date X
(DOB)
Claim Page 01		 X X
(FL 10)		 Enter the patient’s date of birth in MMDDYYYY format.
Patient’s Address X
(ADDR 1–6 and ZIP)
Claim Page 01		 X X
(FL 9)		 Enter the patient’s full mailing address including street name and number, post office box number or RFD, city, state and ZIP Code.
Patient’s Sex X
(SEX)
Claim Page 01		 X X
(11)		 Enter the patient’s sex. Valid values are:
  • M (Male)
  • F (Female)
Admission Date X
(ADMIT DATE) Claim Page 01		 X X
(FL 12)		 Enter the hospice admission date. This date must match the ‘from’ date in the statement covers period and the date reported with OC 27.
Type of Admission   X   Enter a valid type of admission code (1–9).
Admission Source Code   X   Enter the source of admission with the default value of ‘1.’
Patient Status Code   X   Enter the patient discharge status code with the default value of ‘30.’
Condition Codes X
(COND CODES 01‒10)
Claim Page 01		 X X
(FL 18 – 28)		 *Enter D0 (the number zero) if the NOE is correcting an election date.

Note: when D0 is entered on the claim, OC 56 and date must also be submitted. If both codes are not submitted on the NOE, it will be returned to the provider.
Occurrence Codes and Dates X
(OCC CDS/Date 01 ‒10)
Claim Page 01		 X X
(FL 31 – 34)		 *Enter OC 27 and the certification date. This date must match the ‘from’ and admit dates. To correct an election date previously submitted in error, enter OC 56 and the election date reported on the original NOE. The admission date, from date and OC 27 date are submitted with the correct dates.

Note: When OC 56 is submitted on the NOE, Condition Code D0 must also be entered. If both codes are not on the NOE, it will be RTP.
N/A X
(FAC. ZIP)
Claim Page 01		     The entire nine-digit ZIP Code must be entered and should match the facility’s master address in the provider enrollment record (usually the facility’s physical location).
Provider Number X
(NPI)		 X X
(FL 56)		 Enter the NPI associated with the OSCAR number.
N/A X
(OSCAR)
Claim Page 01		     The system will automatically pre-fill the Medicare OSCAR number (the six-digit number assigned by Medicare) when logging on to the DDE system.
Revenue Code   X   Enter the default revenue code 0650.
HCPCS   X   Enter the default HCPCS code Q5009.
Service Date   X   Enter the service date that matches the ‘FROM’ date in the statement covers period.
Total Units   X   Enter the default total units of ‘1.’
Total Charges   X   Enter zeros (0.00)
Payer ID Code X
(CD)
Claim Page 03		 X   Line A–‘Z’ is system generated in DDE.

Claims submitted via EDI will depend upon the software being used. If the software does not auto-populate this field, enter the ‘Z’ to reflect Medicare as the payer source.
Payer X
(PAYER)
Claim Page 03		 X X
(FL 50)		 Line A – ‘Medicare’ is system generated in DDE.

Claims submitted via EDI will depend upon the software being used. If the software does not auto-populate this field, enter ‘Medicare.’
Insured’s Name X
Claim Page 03		 X X
(FL 58)		 Enter the beneficiary’s name on line A as it appears on the beneficiary’s HI card.

Note: All NOEs are submitted with Medicare as the primary payer.
The beneficiary/patient’s Medicare number X
(MID)
Claim Page 01		 X X
(FL 60)		 Enter the beneficiary’s MID.

For claims submitted via EDI, this field may vary depending upon the software used. Check with your vendor if assistance is needed.
Release of Information X
RI)
Claim Page 03		 X X
(FL 52)		 The Release of Information Certification Indicator indicates whether the provider has on file, a signed statement permitting the provider to release data to other organizations in order to adjudicate the claim. Valid values are:
  • I - Informed consent to release medical information for condition or diagnoses regulated by Federal Statutes.
  • Y - Yes, provider has a signed statement permitting release of information.
Principal Diagnosis Code X
(DIAG CODES 01–09)
Claim Page 03		 X X
(FL 66)		 Enter all diagnoses as appropriate.
Attending Physician I.D. X
Claim Page 03		 X X
(FL 76)		 Enter NPI and name of physician or NPP, designated by patient at the time of election as having the most significant role in determination and delivery of patient’s medical care. 
Other Physician I.D. X
(REF PHYS)
Claim Page 03		 X
(Referring)		 X
( FL 78)		 Enter the NPI and name of the hospice physician responsible for certifying the patient’s terminal illness.

Note: When the hospice physician is the attending and certifying physician, only the attending physician NPI is required to be reported.
Provider Representative Signature and Date     X
(FL 80)		 A hospice representative must make sure the required physician’s certification and a signed hospice election statement are in the records before signing the form CMS-1450. A stamped signature is acceptable.

 

An erroneous admission date on the NOE can only be corrected for an admission that occurred on or after 1/1/2018.

*Example of submitting a corrected NOE

 

Initial NOE was submitted with an admit date of 01/08/XX. The actual admit date is 01/07/XX. The hospice reports the following:

Field Descriptor Description/Valid Values
TOB: 8XA
Statement Covers Period Enter 0107XX in the ‘from’ date field
Statement Covers Period Enter 0107XX in the ‘through’ date field if the NOE is being submitted through EDI. Leave this field blank if the NOE is being submitted via DDE
Admission Date Enter 0107XX
Condition Code Enter D0 (ensure that the number zero is entered)
Occurrence Code and Date Enter OC 27 and 0107XX (correct admit date)
Occurrence Code and Date Enter OC 56 and 0108XX (incorrect admit date)

 

**Hardcopy UB-04 Claims may only be submitted by providers that are authorized to do so.

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Reviewed 5/21/2024