Why Timing Matters In Hospice Billing

Do you know the best practices for keeping a timely filing and billing cycle? Hospice billing is a sequential process, and any mistake can throw off the complex process of filing claims and result in delayed reimbursement. Here are a few of our steps for keeping your hospice billing cycle as smooth as possible.

Step 1: Submission of the Notice of Election (NOE)

The first step of the hospice billing cycle is the submittal and processing of a clean, error free NOE. Before hospice claims can be filed, all NOEs must be filed and processed, specifically within 5 days of administration. Any mistakes or issues with filing can result in a rejected NOE which will delay the rest of your sequential billing process and possibly result in non-covered days, causing you to lose reimbursement of the daily rate until a clean NOE is accepted by Medicare.

Step 2: Managing Interactions with Other Hospice Providers

Do you know what other issues you may encounter that will prevent a clean NOE from processing? Previous hospice care can impact and delay your NOE processing if they have not completed their billing and/or revocation. Are you proactive in getting the previous hospice to bill? Do you know what steps Medicare requires you to take before you can file a dispute and ask for their help? Knowing and understanding sequential requirements can help you keep your billing cycle free of errors and delays and move your claims into processing quickly.

What if your patient was a transfer from another hospice agency? Do you know what the previous provider must do in order for your agency to bill? What if they make a mistake that prevents you from billing? You must know what steps should be taken by the previous hospice to correct transfer errors that block your billing, and when to get Medicare involved if corrections are not made timely.

Step 3: Submission of Sequential Claims

As a result of interactions with other hospice providers, billing may be delayed several months and agencies may have multiple claims ready to submit at once. Previously, Medicare would process the first claim only, and providers would have to wait until it was recorded on the CWF before the next claim could be submitted. Providers can now submit multiple months at once, and the subsequent claims will be held in status S location B0100 and will fall into processing automatically once the previous claim moves forward into a payment pending location. Depending on how many claims are submitted at once, it is still possible to have some RTP, so it is important to monitor those claims throughout processing.

Step 4: Submission of the Notice of Termination/Revocation (NOTR)

Just as we discussed in the NOE section above, it is equally important to submit NOTRs timely and accurately for all revocations and discharges. The implementation of the five-day NOE rule included the NOTR, and Medicare instructed providers to file all NOTRs within five days. However, with no immediate financial repercussions for not filing the NOTR timely, this has become an afterthought for many agencies. Filing a late NOTR can absolutely have financial repercussions for your agency! If you do not file an NOTR timely, and the patient returns to your service, the subsequent NOE cannot be filed until your NOTR for the previous election processes. Should you have an error or issue with the NOTR that results in a late NOE, the appeal will most likely be denied due to provider error. Your timely NOTR is just as important as your timely NOE when considering Medicare compliance since both fall under the five-day timely filing rule.

At Advanced Hospice Management, we take the stress of hospice billing off your shoulders. We know the best practices to streamline your billing and ensure that your cycle is smooth and free of errors, and we monitor interactions with other providers to get your claims processed as quickly as possible. For a free review of your hospice billing processes, contact us today.