Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)

Table of Contents

• Hospice Notice of Election Termination/Revocation
• Examples of NOTR Time Frames
• Reminders/Notes on the NOTR
  • Correcting a Discharge Date on an NOTR
  • Diagnosis Codes
• Submitting an NOTR via FISS/DDE
  • Claim Page One
  • Claim Page Three
• Related Content

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Hospice Notice of Election Termination/Revocation

Upon discharge from hospice or revocation of hospice care, the beneficiary immediately resumes the Medicare coverage that had previously been waived by the hospice election. As such, hospices should promptly record the beneficiary’s discharge or revocation in the claims processing system. Doing so protects the beneficiary from experiencing possible delays in accessing needed care.

When a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, hospice providers are required to submit a timely-filed NOTR using TOB 8XB, unless it has already filed a final claim.

A timely-filed NOTR is an NOTR submitted to the Medicare contractor and accepted by the Medicare contractor within five calendar days after the effective date of discharge or revocation. A timely-filed NOTR is an NOTR with a receipt date within five calendar days after the hospice discharge/revocation date and is subsequently processed in status/location P B9997. Hospices continue to have one calendar year from the date of service in which to timely file their claims.

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Examples of NOTR Time Frames

• Timely NOTR: A patient revokes the hospice benefit on 10/8/20XX. The NOTR is submitted on 10/13/20XX and ultimately processes on 10/17/20XX.

• Untimely NOTR: A patient revokes the hospice benefit on 10/8/20XX. The NOTR is submitted on 10/13/20XX and is RTPd on 10/14/20XX due to a billing error. The NOTR is resubmitted on 10/17/20XX and ultimately processes on 10/21/20XX.
  • Currently, there is no financial implication for late NOTRs; therefore, there is no special coding required if the NOTR is not submitted timely. However, be advised if a final claim or NOTR is not submitted within five days of the discharge or revocation and the beneficiary readmits, this could impact the ability to timely submit a NOE. An untimely NOE for a readmission when there is no final claim or NOTR within five days may not qualify for an untimely filed NOE exceptional circumstance.

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Reminders/Notes on the NOTR

The submission of the NOTR will not prevent the final claim from processing. The purpose of the NOTR is to ensure that the CWF is updated quickly so other providers may begin to bill Medicare for services, prior to submitting the hospice final claim. This will give the hospice providers time to gather all of the information in order to submit a complete final claim.

The NOTR is not submitted if the:

• patient dies or transfers to another hospice. The NOTR is only used for live discharges from the Medicare hospice benefit or revocations.
• hospice submits the final claim within five calendar days after the date of discharge/revocation.

The NOTR will RTP if the revocation/termination date does not match a benefit period posted to the CWF. In order for an NOTR to process, the benefit period in which the patient was discharged has to be established in the CWF. For example, if the beneficiary revokes or is discharged on 11/2, but the current benefit period posted in the CWF ends on 10/27, the claim for the October billing period must be submitted to get the subsequent benefit period posted to the CWF before an NOTR will process.

As a reminder, the NOTR only needs to be submitted if the final claim has not yet been submitted. If the final claim can be submitted as soon as the next benefit period has posted to CWF, the provider should submit the final claim and the NOTR is not required. In the example above, the final claim for 11/1–11/2 could be submitted as soon as the benefit period beginning 10/28 is posted to CWF. If the claim cannot be submitted as soon as the 10/28 benefit period has posted to CWF, the NOTR should be submitted.

If you submit an incorrect NOTR, there is a process to remove it from CWF. This process works when only one election period has to be removed. First, cancel all claims within the election period in question. After all claims have been cancelled, submit an 8XD with the start date of the election period in question. Once the 8XD is finalized, this will remove the election period in CWF. Claim can now be resubmitted as appropriate. Note: If additional election periods are involved, work with the PCC for assistance.

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Correcting a Discharge Date an NOTR

The NOTR can be corrected if submitted with an erroneous discharge date. Condition codes are not required on an original NOTR. Hospice may submit an NOTR that corrects a revocation date previously submitted in error. In this case, the hospice reports the correct revocation date in the Through Date Field and reports the original revocation date using occurrence code 56.

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Diagnosis Codes

Diagnosis codes are not required on the NOTR; however, be aware if a diagnosis code is reported in the DIAG CODE field on page 3 of the claims system on a NOTR (TOB 81B or 82B), the claims system will check to ensure the ICD-10 code is valid. If an invalid code is used, the claim will RTP.

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Submitting an NOTR via FISS/DDE

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Claim Page One

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Claim Page Three

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Related Content

• CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims

Revised 7/30/2024