Hospice Claims and Election Statements

Are your Hospice claims getting denied due to Election Statement omissions?

The National Hospice and Palliative Care Organization (NHPCO) began getting calls last year from Hospice agencies complaining that they were getting denials because their Election Statements were found to have missing information. The problem was so widespread that the NHPCO met with the Medicare Administrative Contractors (MACs) to determine the cause and find a solution.

STAR Medical Auditing Services had the pleasure of having a vendor booth at the Home Health & Hospice Expo in Las Vegas in September put on by these MACs (CGS, NGS, and Palmetto). This topic surrounding the denials due to Election Statement omissions was discussed at a roundtable session; a summary of that discussion is as follows:

NHPCO found that there were two different Election Statements floating around and both were found on the Center for Medicare & Medicaid Services’ (CMS) website! The original form was made available by CMS prior to July 2020 when the Final Rule updates for that year were published, and that form was missing the contact information for the BSCC-QI.

All three MACs contacted CMS and received the following guidance:

If a claim was denied because the old Election Statement form was used, they should accept and process the claim if the missing contact information for the BSCC-QI can be found anywhere in the chart AND they can verify that the information was given to the patient on the same day they elected Hospice care.

So the takeaway here is this: if the BSCC-QI contact information is not on your form but is in your Hospice Admit Pack Booklet that you give to the patient, and you have documentation indicating that the booklet was given to the patient on the same day they signed the Election Statement, then all three MACs (CGS, NGS, and Palmetto) will accept it and the claim will be paid (assuming all other requirements were met).

They also stressed NOT to use Google when searching for form templates, but to ALWAYS go directly to the CMS website found at www.CMS.org for the correct version of all forms, examples, templates, etc.