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 NOE is submitted after the beneficiary has signed the election statement and is only submitted once.

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 (Occurrence Code 32)
- Room and Board
Influenza Virus Vaccine
Untimely Certification/Recertification

Additional Resources

Claims Main Web Page – The Claims Web page provides a variety of resources related to filing, correcting, adjusting, and the processing of Medicare claims, additional development requests (ADRs), credit balance reports, reference tools, claims submission errors, common questions, and payment information.
Timely Filing Requirements — Section 6404 of the Patient Protection and Affordable Care Act (PPACA) amended the timely filing requirements to reduce the maximum time period for submission of all Medicare claims to one calendar year after the date of service. For additional information, refer to Change Request 6960 — Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months.
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.