Transferring Beneficiary From/To Another Hospice Agency

Once in each election period, a beneficiary may change the designation of which hospice he or she wishes to receive care from. Before accepting transfer beneficiaries, you need to determine:

When did the beneficiary elect the hospice benefit?
What benefit period is the beneficiary in?
Has the beneficiary ever transferred before? If so, when?

Transfers from Your Agency	Transfer to Your Agency
Submit your final claim promptly to allow the agency receiving the transferring beneficiary to submit their Notice of Change (NOC). Both the transferring and receiving hospice agencies may bill the day of transfer. In addition to the usual claim information, report the following on your final claim indicating the transfer: TOB—Enter the type of bill (TOB) 811 or 821 if this is the only claim you are submitting for the beneficiary. Enter the TOB 814 or 824 if you have previously submitted hospice claims for this beneficiary. STAT field on Fiscal Intermediary Standard System (FISS) Claim Page 01—Enter patient status code “50”, if the beneficiary is transferring to another hospice under routine or continuous home care. Enter patient status code “51” if the beneficiary is transferring to another hospice under respite or general inpatient care. REMARKS field on Claim Page 04—Enter the name, address, and provider number of the receiving hospice agency. Note: Do not use occurrence code 42 for a transferring beneficiary.	Submit a Notice of Change (NOC), prior to submitting your first claim. This indicates that the admission is a continuation of the current benefit period. The NOC must be submitted after the transferring hospice agency has submitted their final claim. To submit the NOC, enter the same information as you would for a notice of election, except for the following: TOB—Enter the type of bill (TOB) 81C or 82C STMT DATES FROM field on the Fiscal Intermediary Standard System (FISS) Claim Page 01—Enter the date your agency started hospice care. ADMIT DATE field on the FISS Claim Page 01—Enter the date your agency started hospice care for the transferring beneficiary. REMARKS field on Claim Page 04—Enter the name, address, and provider number of the hospice agency the beneficiary transferred from. Note: The NOC (81C or 82C) must process before your agency may submit the first claim.

Transfers from Your Agency

Transfer to Your Agency

Submit your final claim promptly to allow the agency receiving the transferring beneficiary to submit their Notice of Change (NOC). Both the transferring and receiving hospice agencies may bill the day of transfer.

In addition to the usual claim information, report the following on your final claim indicating the transfer:

TOB—Enter the type of bill (TOB) 811 or 821 if this is the only claim you are submitting for the beneficiary. Enter the TOB 814 or 824 if you have previously submitted hospice claims for this beneficiary.
STAT field on Fiscal Intermediary Standard System (FISS) Claim Page 01—Enter patient status code “50”, if the beneficiary is transferring to another hospice under routine or continuous home care. Enter patient status code “51” if the beneficiary is transferring to another hospice under respite or general inpatient care.
REMARKS field on Claim Page 04—Enter the name, address, and provider number of the receiving hospice agency.

Note: Do not use occurrence code 42 for a transferring beneficiary.

Submit a Notice of Change (NOC), prior to submitting your first claim. This indicates that the admission is a continuation of the current benefit period. The NOC must be submitted after the transferring hospice agency has submitted their final claim.

To submit the NOC, enter the same information as you would for a notice of election, except for the following:

TOB—Enter the type of bill (TOB) 81C or 82C
STMT DATES FROM field on the Fiscal Intermediary Standard System (FISS) Claim Page 01—Enter the date your agency started hospice care.
ADMIT DATE field on the FISS Claim Page 01—Enter the date your agency started hospice care for the transferring beneficiary.
REMARKS field on Claim Page 04—Enter the name, address, and provider number of the hospice agency the beneficiary transferred from.

Note: The NOC (81C or 82C) must process before your agency may submit the first claim.

Reference: Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, §20.2

Page last updated: March 26, 2008