On November 6th CMS issued Change Request CR 8923. CR8877 established an exception process where, in certain exceptional circumstances, a hospice can request the MAC to waive the consequences of filing the NOE late. The hospice files the associated claim with occurrence span code 77 used to identify the non-covered, provider liable days. The hospice also reports a KX modifier with the Q HCPCS code reported on the earliest dated level of care line on the claim. The KX modifier prompts the MAC to request the documentation supporting the request for an exception. Based on that documentation, the MAC shall determine if a circumstance encountered by a hospice qualifies for an exception.
If the MAC approves the request for an exception, the MAC processes the claim and removes the submitted provider liable days, which will allow payment for the days associated with the late-filed NOE. If the MAC finds that the documentation does not support allowing an exceptional circumstance, the MAC shall process the claim as submitted. Due to a system limitation, the provider liable days on these claims currently receive remittance advice remark code N211 (Alert: You may not appeal this decision) in error. The exception requests decisions are appealable. The purpose of CR8923 is to correct this error.
The provider liable days on these claims will receive the following remittance advice codes:
* Group Code CO;
* Remittance Advice Remarks Code 96; and
* Claim Adjustment Reason Code MA54
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