Home Health

CMS clarifies medical review requirements for new hospice election statement addendum

A new transmittal to MACs issued Oct. 21, 2021, notes the manual updates for clarification on the election statement addendum requirements.

Key among the changes included in the hospice rule that went into effect Oct. 1, 2021:

  • Hospices have five days to furnish the addendum if requested within the first five days of the effective date of the election. Otherwise, they have three days.
  • Hospices must include the “date furnished” on the addendum.

CMS also noted medical review requirements for the MACs:

  • If it is clear based on received documentation that the beneficiary requested but did not receive the addendum within the time period specified at 42 CFR 418.24(c), the failure to provide such addendum should result in a claims denial. The contractor should request the addendum to accompany any additional documentation request to mitigate such denial.
  • A denial resulting from a violation of this specific condition for payment would be limited to only the claim subject to review —it would not invalidate the entire hospice election.

Read the full Transmittal 11056.