CMS Creates New Process for Late NOE Appeals

If you are associated with a hospice, you are aware of the new rules regarding the timely filing of NOEs.  You can review these rules in my previous article or through this CMS announcement:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3032CP.pdf

cmsnoelateappeals

By now, you have made it through October claim processing and hopefully you experienced as few late NOEs as possible.  If you did have some late NOEs, you might still be able to recover this lost revenue.

In the original announcement, CMS gave the MACs the authority to process appeals for late NOEs and gave the circumstances where these appeals might be granted.  If an appeal is successful, uncovered charges could be reversed by the MACs.

On 11/6, CMS issued another announcement regarding the appeals process for late NOEs:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3118CP.pdf

As described in the original announcement, whenever an NOE is filed late (entered in DDE over five days after the admission date), the hospice must report the late NOE on the first claim for the initial hospice benefit period.  This is done by reporting the non-covered days with occurrence span code 77, even if the hospice believes that the NOE is late for reasons eligible for an appeal. Continue reading