A change in primary payer requires a discharge & readmit along with new clinical legal paperwork, due to the listed Medicare rules and regulations.
*It is imperative that the Provider set the appropriate primary payer upon admit, failure to do so could result in loss of revenue.
Payers expect the Provider to determine the correct payer source upon admit and not having the correct payer that results in a late NOE or failure to obtain an authorization is not an acceptable appealable reason.
The date on your hospice paperwork must match the NOE (Notice of Election) start date because it establishes the effective date of your hospice benefit period. This ensures that Medicare coverage for hospice care is accurate and aligns with the patient's enrolment
Medicare Claims Processing Manual Chapter 11-Processing Hospice Claims
Explanation/Definitions:
Notice of Election (NOE):The NOE is a form submitted to Medicare and other payers (like CCA) when a patient chooses to enroll in hospice care.
Benefit Period: The NOE establishes the start date of your hospice benefit period, which is the period for which hospice care is covered.
Timely Filing: The NOE must be filed within a certain timeframe after the patient's admission date to Medicare. For out-of-network providers, this is generally within 5 business days; for in-network providers, it's within 7 business days.
Coordinated Dates: The date on your admission paperwork, which is the date you are admitted to hospice care, must match the start date of your benefit period as reported on the NOE. This ensures that Medicare is aware of the exact period for which they are responsible for coverage.
Medicare Coverage: If there is a discrepancy between the admission date and the NOE start date, it can lead to issues with Medicare billing and coverage. Medicare may not cover care from the date of admission until the NOE's start date is accepted, potentially resulting in a provider liability.
In essence, the matching dates ensure that Medicare and other payers understand the official start date of your hospice benefit and can process claims correctly.