Hospice Claims Filing
The Medicare hospice benefit requires that providers submit two types of billing transactions; the Notice of Election (NOE) and the claim. The NOE (an abbreviated claim) is submitted to notify the Medicare contractor, and the Common Working File (CWF) of the start date of the beneficiary’s election to the hospice benefit.
The first claim is submitted, only after the NOE has processed. Before billing the first claim to Medicare, review the sequential billing requirements. Hospice claims must be submitted and processed in date order. After the first claim processes, the subsequent claim can then be submitted. Claims must also be submitted monthly and should not span a two month period. For example, claims for September and October must be submitted separately due to changes to reimbursement rates. Claims for October and November must also be submitted separately due to the end of the hospice “cap period”.
The Fiscal Intermediary Standard System (FISS) Claims/Attachments option (FISS Main Menu option 02) allows you to enter NOEs and hospice claims. The following provides screen prints and field descriptions for each of the six FISS claim pages and identifies which pages/fields are required for NOEs and hospice claims. For more detailed information about FISS, refer to the FISS Reference Guide.
Notice of Elections (NOEs)
Hospice Claims
Special Hospice Claims Filing Situations
- Canceling a Notice of Election or Benefit Period
- Transferring Beneficiary From/To Another Hospice Agency
- Change of Ownership
- Discharge or Revocation of Hospice Care
- Add-on (Late Charges) Claim
- Occurrence Code 42 Omitted
- Requests for Medical Denials
- Hospice No-Pay Bills (Condition Code 21)
- Advance Beneficiary Notice (Condition Code 32)
- Room and Board
- Influenza Virus Vaccine
Additional Resources
- Medicare
Claims Processing Manual
(CMS Pub. 100-04, Ch. 11)—Chapter
11 of the Medicare Claims Processing Manual provides information
about the Medicare hospice benefit including billing, payment, caps
and limitations, and medical review of hospice claims. - Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 25)—Refer
to Chapter 25 for a complete description of all the items included
on the CMS-1450 (UB-04) claim form.
- Hospice Quick Reference Tools—A variety of tools developed by the Cahaba’s Provider Outreach and Education staff are available to assist in the successful processing of your claims.
Page last updated: April 14, 2008
