Hospice Election Period Changes

This month is bringing some significant changes to the way hospice providers handle election periods. Effective July 2, 2018, the Common Working File (CWF also known as FISS DDE) has been modified to keep election and revocation date information separate from benefit period information.  This change will make correction to either of those pieces of information much easier under the new format.

Hospices will not need to do anything to see the changes or make any data conversions.  CMS and your intermediary has made the transition for you. Current benefit periods and those up to 4 years old will be included in the conversion. The new enhancements will create an election period that is separate from benefit periods when the Notice of Election (NOE, TOB 8XA) is keyed into FISS.

Other important information hospices must be aware of include:

  • Benefit periods can be canceled without removing the NOE period.
  • Notice of Termination/Revocation (NOTR) can be submitted at any time instead of when the benefit period from claim data is processed.
  • Benefit periods will be removed automatically when claims are cancelled.

Providers need to be aware that the submission of the 8XA no longer creates a benefit period. Benefit periods are going to be strictly dependent on claim data. Voiding and cancelling a benefit period (TOB 8XD) will also no longer be needed. FISS will automatically cancel the benefit period only when a claim is cancelled.  Page 9 of the CWF/FISS claim data will not change.

Submitting a NOTR (TOB 8XB) will post a revocation date in the new election period screen.  The revocation indicator will change to 1. A corrected revocation date using the 56/D0 process will also show on this new election screen.  CMS’ goal for this change is to reduce the need for NOE timely filing appeals.

NOTR from dates will now have a new submission procedure.  If the provider remains the same during an election, you will need to submit the start date of the election period as the ‘from’ date on the NOTR.  Do not use the start date of the current benefit period. Should the revocation follow a transfer, the NOTR from date must be the same and match the Start Date2 on the benefit period that initiated the transfer. Don’t forget, the admission date on the NOTR must continue to always match the ‘from’ date.

Cancelling and voiding will continue to be dependent on TOB 8XD.  You will continue to follow the same process you do now for removing an election period and removing a transfer that was submitted in error. Please be sure to closely pay attention to the ‘from’ date.

FISS reason code U5106 will indicate that another NOE has been attempted to be filed without prior elections being revoked.   The first claim submitted by the hospice must always reflect the from admission date matching the election period start date. Failure to do so will cause a rejection as well.

Hospices must be ready for these changes as it will directly impact your cash flow and reimbursement.  However, don’t be shy…we are available to help and answer any questions you may have.  Please call or email if you do have questions about the new changes.  We look forward to hearing from you!