NOTR (CMS) · CMS
Filed when a hospice beneficiary is discharged alive or revokes the election. Must be submitted within 5 calendar days of the effective date.
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Submit electronically to CMS through the FISS
The hospice provider submits the Notice of Termination/Revocation (NOTR) to the MAC.
Filing Deadline
Must be submitted within 5 calendar days of the revocation, discharge, or transfer effective date.
Processed by the MAC within 1-3 business days. Restores regular Medicare benefits effective the termination date.
CMS updates the Common Working File to reflect the end of the hospice election. Regular Medicare benefits resume for the terminal condition. If the patient revoked, they can re-elect hospice at any time during a new benefit period.
Hospice Election (CMS model) · CMS / Hospice Agency
Elects the Medicare hospice benefit. Identifies the hospice and attending physician. Acknowledges waiver of curative treatment for the terminal illness. Triggers two 90-day benefit periods followed by unlimited 60-day periods.
Hospice Certification (CMS) · CMS
Physician certification that the patient has a terminal illness with a prognosis of 6 months or less. Required at the start of each benefit period. Face-to-face encounter required before the third benefit period and each subsequent period.
NOE (CMS electronic) · CMS
Electronic notification to Medicare contractor that a beneficiary has elected hospice. Must be filed within 5 calendar days of the election effective date. Late filing results in provider liability for uncovered days.
Revocation Statement · Hospice Agency
Written statement revoking hospice election for a specific benefit period. Patient may re-elect hospice for remaining benefit periods. Verbal revocation is not acceptable; must be in writing.
Transfer Form · Hospice Agency
Change of designated hospice provider (allowed once per election period). Not a revocation. Receiving hospice files a new NOE; benefit period dates are unaffected.
Discharge Order · Hospice Agency
Written physician order required before discharging a patient for any reason other than revocation, transfer, or death. Documents the clinical rationale for discharge.
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