National Government Services, Inc. has a long history of supporting federal health agencies such as the CMS. Throughout the country, NGS has efficient operation, financial and human resources in place that position the organization as a national leader in Medicare for 55 years.

Have a Medicare billing question? Visit NGSMedicare.com

National Government Services, Inc. (NGS) serves as your Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor for Original Medicare Part A (hospital), federally qualified health centers (FQHCs)/rural health clinics (RHCs), home health and hospice (HH+H) and Part B (medical) services in our contracted states and territories. NGS processes claims, issues payment and provides customer service for those Medicare-enrolled providers; click the About Us link on our website for details.

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Top Denial Hospice Claims

Has your hospice recently received a claim denial? Here are the top denial claims affecting hospice agencies in California. CHAPCA can help refer you to the appropriate education to help rectify these issues. 

Technical Denials

1. Invalid Hospice Election Statement:

• Need to clearly identify the effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement.  
• Please reference the Hospice Notice of Election Statement sample in MLN Matters SE1631 Revised.

CHAPCA recommends:

Sharp Curves Ahead: Is Your Hospice Documentation & Practice Able to Withstand Audit Scrutiny?

2. Incomplete/Invalid Certification/Recertification's of Terminal Illness:

• Untimely signed certifications of terminal illness (COTI) and missing the attending's COTI (if elected on Notice of Election Statement).

For the first 90-day period of hospice coverage, the hospice must obtain, no later than 2 calendar days after hospice care is initiated, (that is, by the end of the third day) oral or written certification of the terminal illness by the medical director of the hospice or the physician member of the hospice IDG, and the individual's attending physician if the individual has an attending physician. 

• The certification of terminal illness is missing a valid statement directly above the physician signature attesting that by signing, the physician confirms that he/she composed the narrative based on his/her review of the patient's medical record or, if applicable, his or her examination of the patient. 

CHAPCA recommends:

2021 Hospice Billing Series: Hospice Billing Part 1 Eligibility Requirements & Notice of Election

Documentation does not support a terminal prognosis per the Local Coverage Determination (LCD) for Hospice - Determining Terminal Illness (L33393).

Provider should document clear, detailed information that is disease and/or non-disease specific showing a decline in clinical status to support a terminal illness of six months or less.

CHAPCA recommends: 

CHAPCA's Clinical vs. Terminal 4 Part Series covering tools (PPS, FAST, NYHA), Neurological Care, Cardiac Care, and Respiratory Care.

General Inpatient Services

General inpatient services are being billed after the beneficiary's symptoms have stabilized. The documentation and interventions need to show that general inpatient care is being provided in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings.

How to Avoid the Top Five Survey Deficiencies & Denials

For a listing of the top Claim Errors in Hospice, click HERE.