CMS Pub. 100-04, ch. 11, § 20.1.5

A change of ownership notice is used when the beneficiary will remain with the same hospice, but the

person or group running the hospice is changing. A change of ownership typically occurs when a

Medicare provider has been purchased (or leased) by another organization.

Type of Bill

Enter the appropriate 3-digit numeric type of bill code, according to the following code structure:

81E - Hospice (Non-hospital Based) Change of Ownership

82E - Hospice (Hospital Based) Change of Ownership

Statement Covers Period (From-Through)

The “From” date would be the date the change is effective. No through date is required.

Patient’s Name

The patient’s name is shown with the surname first, first name, and middle initial, if any.

Patient’s Address

The patient’s full mailing address including street name and number, post office box number or RFD,

city, State, and ZIP code.

Patient’s Birth Date

Show the month, day, and year of birth numerically as MM-DD-YYYY.

Patient’s Sex

Show an “M” for male or an “F” for female. This item is used in conjunction with diagnoses and

surgical procedures to identify inconsistencies.

Admission Date

The hospice enters the admission date, which must be the start date of the benefit period in all cases

except when a transfer occurs.

The date of admission may not precede the physician’s certification by more than 2 calendar days,

and is the same as the certification date if the certification is not completed on time.

EXAMPLE

The hospice election date (admission) is 01/01/XX. The physician’s certification is dated 01/03/XX.

The hospice date for coverage and billing is 01/01/XX. The first hospice benefit period ends 90 days

from 01/01/XX. Show the month, day, and year numerically as MM-DD-YY.

Condition Codes

Condition codes are not required on an original change of ownership notice. If the hospice is

correcting the effective date of a change using occurrence code 56, the hospice reports condition code

D0. If the two codes are not reported together, the transfer notice will be returned to the hospice.

Occurrence Codes and Dates

Hospices may submit a change of ownership notice that corrects the effective date of a change

previously submitted in error. In this case, the hospice reports the correct effective date of the change

of ownership in the From Date field and reports the original, incorrect effective date using occurrence

code 56. Medicare systems use the original, incorrect date to find the benefit period to be corrected,

then replaces the effective date of the change of ownership with the corrected information.

Release of Information

Valid values are:

I-Informed consent to release medical information for condition or diagnoses

regulated by Federal Statutes,

Y-Yes, provider has a signed statement permitting release of information.

Provider Number

The hospice enters their NPI. When a hospice agency changes ownership and a new

Medicare provider number issued, the A/B Medicare Administrative Contractor (MAC)

must be notified to update the provider number in the hospice period. This will avoid

mistaking the change as a beneficiary-elected transfer.

Insured’s Name

Send all NOEs with Medicare as the primary payer. Enter the beneficiary’s name on line

A. Show the name exactly as it appears on the beneficiary’s HI card.

Insured’s Unique Identifier

On the same lettered line (A, B, or C) that corresponds to the line on which Medicare

payer information is shown enter the patient’s unique identifier by the health plan for the

insured. For example, if Medicare is the primary payer, enter the MBI. To ensure

accuracy and prevent a delay in the timely receipt or posting the hospice notice of

election, hospices should validate this information using the Health Insurance Portability

and Accountability Act (HIPAA) Eligibility Transaction System (HETS). Only in the

event that the HETS data is not available should the hospice show the number as it

appears on the patient’s HI Card, Social Security Award Certificate, Utilization Notice,

EOMB, Temporary Eligibility Notice, etc., or as reported by the SSO.

Principal Diagnosis Code

CMS accepts only HIPAA approved ICD-9-CM or ICD-10-CM/ICD-10-PCS codes,

depending on the date of service. The official ICD-9-CM codes, which were updated

annually through October 1, 2013, are posted at

http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html

The official annual updates to ICD-10-CM and ICD-10-PCS codes are posted at

http://www.cms.gov/Medicare/Coding/ICD10/index.html

Use full diagnosis codes including all applicable digits, up to five digits for ICD-9-CM

and up to seven digits for ICD-10-CM.

Attending Physician I.D.

The hospice enters the name and provider identifier of the attending physician designated

by the patient at the time of election as having the most significant role in the

determination and delivery of the patient’s medical care. The patient’s designated

attending physician could be an independent physician, hospice physician, a nurse practitioner, or

physician assistant. If there is no attending physician listed, then the hospice shall report the hospice

certifying/recertifying physician.

Other Physician I.D.

The hospice enters the name and provider identifier of the hospice physician responsible for

certifying/recertifying that the patient is terminally ill, with a life expectancy of 6 months or less if the

disease runs its normal course. For electronic claims, this information is reported in Loop ID 2310F –

Referring Provider Name.

NOTE: Both the attending physician and other physician fields should be completed unless the

patient’s designated attending physician is the same as the physician certifying/recertifying the

terminal illness. When the attending physician is also the physician certifying/recertifying the

terminal illness, only the attending physician field is required to be populated, the other physician

field would not need to be populated.

Provider Representative Signature and Date

A hospice representative must make sure the required physician’s certification, and a signed hospice

election statement are in the records before signing the Form CMS-1450. A stamped signature is

acceptable.

20.1.6 Hospice Election Periods and Benefit Periods in Medicare Systems

(Rev. 4280, Issued: 04-19-2019, Effective: 07-21-19, Implementation: 07-21-19)

Election Periods

An election period as described in CFR § 418.21 is the initial 90-day period, subsequent 90-day period; or an unlimited

number of subsequent 60-day periods. In the Medicare systems the term ‘election period’ is used to describe the overall

period between an election and revocation, which may include multiple 90-day or 60-day periods. Medicare systems

refer to the 90-day or 60-day periods as ‘benefit periods.’ Therefore, hospices should be aware that when they see

references to ‘election periods’ in regulation or in the Medicare Benefit Policy Manual, they are referring to what is

called a ‘benefit period’ for purposes of claims processing.

Hospice election and revocation date information are stored in a separate election period in Medicare systems from

benefit period information, so the two types of information can be changed independently. Both election periods and

benefit periods are stored in Medicare’s Common Working File (CWF) and can be viewed via inquiry screens.

When a hospice submits an NOE (TOB 8xA), Medicare systems create an election period. The election period file for

each beneficiary contains the following data elements for each of their election periods:

• Period Number – a sequential number assigned to each election period

• Elect Date – the date of election reported in the From date of the NOE

• Receipt Date – the receipt date of the NOE that created the election period

• Revoc Date –the revocation date reported in the Through date of the NOTR or of a discharge claim

• Revoc Ind – a revocation indicator assigned when the revocation date is recorded

• Provider – the CMS Certification Number (CCN) of the hospice that submitted the NOE

• NPI – the National Provider Identifier of the hospice that submitted the NOE.

When an 8xA is processed, the election date and receipt date will be updated on the election period CWF inquiry

screen. The revocation date remains blank and the revocation indicator is 0.

The NOE receipt date will be retained on the election period permanently. If benefit periods are cancelled, this will not

remove the NOE receipt date from Medicare systems. If the election date is changed using the occurrence code

56/condition code D0 process described above, the NOE receipt date will not change.

When a hospice submits an NOTR (TOB 8xB), Medicare systems will post a revocation date on the election period and

change the revocation indicator to 1. Similarly, if a revocation date is corrected using the 56/D0 process, the correct

date will be displayed on the election period.

If the hospice files the discharge claim in lieu of the NOTR, the claim will also post the revocation date and revocation

indicator on the election period, in addition to updating the Term Date1 of the benefit period to match the revocation

date.

A later NOE for the same beneficiary when there is no revocation date on the election period will be rejected.

Consistent submission of revocations, via NOTRs or claims, within 5 days of the revocation date as required by

regulation, is very important to prevent this.

When a hospice submits a Change of Provider/Transfer Notice (TOB 8xC) or a Change of Ownership Notice (TOB

8xE), this will make no changes to the election period.

Benefit Periods

The hospice benefit period file pre-existed the episode period file and retains all the same fields it had historically, but

election-related fields on those screens will no longer be used.

The hospice benefit period file for each beneficiary contains the following data elements for each of the benefit periods

they use while receiving hospice care:

• Start Date1 – the start date of the benefit period

• Term Date1 -- the end date of the benefit period

• Prov1 -- the CCN of the hospice whose claim created the benefit period

• Inter1—a number identifying the Medicare Administrative Contractor serving Prov1

• DOEBA Date – date of earliest billing activity, the first date billed in the period

• DOLBA Date – date of latest billing activity, the Through date of the last claim processed in the period.

• Days Used – the number of days in the period used to date

• Start Date2 – the effective dates of a transfer during the period

• Prov2 -- the CCN of the hospice from the 8xC transfer notice.

• Inter2 -- a number identifying the Medicare Administrative Contractor serving Prov1

• Revocation Ind – no longer used.

Benefit period contain two columns of information. One captures information on the original billing hospice and any

hospice receiving a transfer. A second column, labelled “Owner Change” captures information about a change of

ownership to either of these hospices.

Benefit periods are created by submitting claims. Benefit period information supports claims processing functions only,

while the election period carries only the beneficiary’s election status.

If a hospice needs to cancel all the claims in a benefit period, Medicare systems will remove the hospice benefit period.

The first claim submitted by the hospice after an election must ensure the From and Admission dates match the election

period start date. This will ensure the first benefit period in the election is created correctly and subsequent claims will

process.

When a hospice submits a Change of Provider/Transfer Notice (TOB 8xC) or a Change of Ownership Notice (TOB

8xE), this will post the Start Date2 and Prov2 information on the hospice benefit period.

When a hospice submits a Change of Ownership Notice (TOB 8xE), this will post an Owner Change start date on the

benefit period.

Summary Chart

The following chart provides a reference to help hospices understand which of their submissions will impact an election

period or a benefit period.

Effects of Election Periods

Effects of Benefits Periods

Transaction Type Type

of

Bill

Creates

Election

Period

Changes

Existing

Election

Period

Removes

Election

Period

Creates

Benefit

Period

Changes

Existing

Benefit

Period

Notice of Election

Period

8xA Always OC 56

only

Never Never Never

Notice of

Termination/Revocation

8xB Never Always Never Never Makes Term

Date match

revocation

date

Transfer Notice 8xC Never Never Never Only when

no claims

have created

periods for

previous

hospice

Always

Void/Cancel of Election 8xD Never Never Always Never Never

Change of Ownership

Notice

8xE Never Never Never Only when

no claims

have created

Always

Effects of Election Periods

Effects of Benefits Periods

Transaction Type Type

of

Bill

Creates

Election

Period

Changes

Existing

Election

Period

Removes

Election

Period

Creates

Benefit

Period

Changes

Existing

Benefit

Period

periods for

previous

hospice

Admit thru Discharge

Claim

8x1 Never Adds

revocation

date and

rev ind., if

not a

transfer

Never Always Always

Admission Claim 8x2 Never Never Never Always Always

Continuing Claim 8x3 Never Never Never If OC 27 is

present and

“Through”

date spans

end of

current

period

Always

Discharge Claim 8x4 Never Adds

revocation

date and

rev ind., If

not a

transfer

Never If OC 27 is

present and

“Through”

date spans

end of

current

period

Always