Reporting Hospice Discharges, Revocations and Transfers

Medicare regulations at 42 CFR 418.26 outline three reasons for discharge from hospice care:

1. The beneficiary moves out of the hospice’s service area or transfers to another hospice;
2. The hospice determines that the beneficiary is no longer terminally ill; and
3. The hospice determines the beneficiary meets their internal policy regarding discharge for cause.

The CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11 Processing Hospice Claims, Section 418.26 also specifies that any discharge from hospice care other than an immediate transfer to another hospice has the following effects:

1. The beneficiary is no longer covered under Medicare for hospice care;
2. The beneficiary resumes Medicare coverage of the benefits waived by their hospice election; and
3. The beneficiary may at any time elect to receive hospice care if he or she is again eligible.

Final Claim Billing Instructions

Beneficiary Moves out of Service Area without a Transfer

A beneficiary may move out of the hospice’s service area either with, or without, a transfer to another hospice. In the case of a discharge when the beneficiary moves out of the service area without a transfer, report the NUBC approved discharge status code that best describes the beneficiary’s situation. You must also report CC 52 to indicate that the discharge is due to the patient’s unavailability or inability to receive hospice services from the hospice that has been responsible for the patient (in such a circumstance, the patient is considered to have moved out of the hospice’s service area).

Examples of when such a code could be used include, but are not limited to, when a hospice patient moves to another part of the country or when a hospice patient leaves the area for a vacation. This code would also be appropriate when a hospice patient is receiving treatment for a condition unrelated to the terminal illness or related conditions in a facility with which the hospice does not have a contract, and thus is unable to provide hospice services to that patient.

Medicare’s expectation is that the hospice provider would consider the amount of time the patient is in that facility before making a determination that discharging the patient from the hospice is appropriate.

Do not report OC 42. The discharge claim will terminate the beneficiary’s current hospice benefit period as of the “through” date on the claim.

Beneficiary Moves out of Service Area with a Transfer

In the case of a discharge when the beneficiary moves out of the hospice’s service area and transfers to another hospice, report discharge status code 50 or 51, depending on whether the beneficiary is transferring to home hospice or hospice in a medical facility. Do not report OC 42. The discharge claim does not terminate the beneficiary’s current hospice benefit period. More Information on reporting transfers for the discharging and admitting hospice can be found in the Hospice Transfers job aid.

Beneficiary is no Longer Terminally Ill

In the case of a discharge when the hospice determines the beneficiary is no longer terminally ill, report the NUBC approved discharge status code that best describes the beneficiary’s situation. Do not report OC 42. The discharge claim will terminate the beneficiary’s current hospice benefit period as of the “through” date on the claim.

Discharge for Cause

In the case of a discharge for cause, report the NUBC-approved discharge status code that best describes the beneficiary’s situation. Do no report OC 42. Instead, report condition code H2 to indicate a discharge for cause. The effect of this discharge claim on the beneficiary’s current hospice benefit period depends on the discharge status. If the beneficiary is transferred to another hospice (discharge status codes 50 or 51) the claim does not terminate the beneficiary’s current hospice benefit period. If any other appropriate discharge status code is used, the discharge claim will terminate the beneficiary’s current hospice benefit period as of the “through” date on the claim.

Late Face-to-Face Encounters

If the required face-to-face encounter does not occur on time, the hospice must discharge the patient from the Medicare hospice benefit because he or she is not considered terminally ill for Medicare purposes. Report the NUBC approved discharge status code that best describes the beneficiary’s situation. Do not report an OC 42. The discharge claim will terminate the beneficiary’s current hospice benefit period as of the “through” date on the claim.

Where the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospice’s failure to meet the face-to-face requirement, we would expect the hospice to continue to care for the patient at its own expense until the required encounter occurs, enabling the hospice to re-establish Medicare eligibility. Occurrence span code 77 does not apply when the face-to-face encounter has not occurred timely.

Beneficiary Decides to Revoke the Medicare Hospice Benefit

If the beneficiary chooses to revoke the Medicare hospice benefit, report the NUBC approved discharge status code that best describes the beneficiary’s situation and report OC 42 along with the effective date of revocation. The final claim will terminate the beneficiary’s current hospice benefit period as of the OC 42 date on the claim.

Below is a quick-reference chart to assist with these final claim billing instructions.

*Notes on discharge for cause:

The effect of the discharge for cause claim on the current hospice benefit period depends on the discharge status:

• If the beneficiary is transferred to another hospice (discharge status codes 50 or 51)
  • Claim will not terminate the current hospice benefit period
  • Admitting hospice will submit a notice of change of provider (type of bill 8XC)
• If any other appropriate discharge status code is used
  • Claim will terminate the current hospice benefit period as of the “through” date on the claim

Did You Know?

Remarks are required on final claims. More information on the use of remarks can be found in the Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims job aid.

Notice of Election Termination/Revocation Requirements

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 record the beneficiary’s discharge or revocation in the claims processing system promptly. Doing so protects the beneficiary from experiencing possible delays in accessing needed care.

With the implementation of CR 8877 for claims with dates of service on or after 10/1/20XX, when a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, hospice providers are now 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 that is 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 that has 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 12 months from the date of service in which to file their claims timely.

Examples of NOTR Timeframes:

• 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.

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.

You do not submit an NOTR when:

• The beneficiary transfers to another hospice
• The beneficiary dies while on the hospice benefit

You must submit a NOTR within five calendar days if a final claim has not been submitted if:

• The beneficiary revokes the benefit, or
• The beneficiary is discharged alive from the benefit

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 November 2^nd, but the current benefit period posted in the CWF ends on October 27^th, 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 has 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 November 1^st through November 2^nd could be submitted as soon as the benefit period beginning October 28^th is posted to CWF. If the claim cannot be submitted as soon as the October 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, you will have to 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. You can then begin resubmitting your claims as appropriate. Note that if additional election periods are involved, you will have to work with the Provider Contact Center for assistance.

Related Content

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

Reviewed 5/20/2024