Hospice Notices and False Billing Days: The Date on the Notice Is Money on the Claim

Hospice notice of election late billing becomes a false-claims issue when a hospice knowingly charges Medicare for days it must absorb. Unless an exception applies, the hospice bears the cost from the election’s effective date through the day before Medicare accepts the late notice. It cannot pass that bill to the patient. Billing those days anyway shifts the hospice’s loss onto taxpayers.

This part of hospice billing fraud turns on the dates behind the payment. For someone in intake or billing, the evidence may already be familiar: when the patient signed, when the contractor accepted the notice, and which days the company charged to Medicare.

What the Election and Notice Do

The hospice election statement records the patient’s choice of hospice care. The Notice of Election tells the Medicare contractor that the choice has taken effect. The patient signs the election statement, or a representative signs when the patient is incapacitated. The hospice sends the notice to its Medicare Administrative Contractor.

Under Medicare’s hospice election rule, the statement identifies the hospice and attending physician and records the patient’s understanding of hospice care and the Medicare benefits being waived. Its effective date can be the first day of hospice care or a later date. It cannot precede the date of the election statement.

That choice changes who gets paid for the patient’s health care. Medicare pays for care related to the terminal illness through the chosen hospice, with exceptions for provider arrangements and an independent attending physician. Coverage remains available for qualifying unrelated healthcare. The notice puts the election into the claims system so Medicare can enforce that payment arrangement.

The physician’s certification supplies another part of the payment record. The Centers for Medicare & Medicaid Services requires written certification for each benefit period, even when the original election continues, and requires it on file before the hospice submits a claim.

What If a Hospice Election Statement Is Incomplete?

An incomplete hospice election statement can leave the hospice without the required record of the patient’s choice to receive care. Medicare requires a signature, effective date, hospice identification and acknowledgments about the care and benefits being waived. The billing question is concrete: what did the patient authorize, and what did the hospice bill?

When Do I Need a Hospice Election Statement Addendum?

For elections beginning on or after October 1, 2026, the hospice must provide a written election statement addendum within the first five days of the election’s effective date and retain it with the statement. It identifies conditions, items, services and drugs the hospice considers unrelated and will not cover, with a clinical explanation the patient can understand.

The earlier rule made the addendum available on request. Now the hospice must provide it without waiting to be asked, with an exception for patients who die, revoke or leave within that period before receiving it. It records what the hospice says falls outside its responsibility, a useful comparison when the claims tell a different story.

Hospice Notice of Election Late Filing Days, Payment and Acceptance

A timely NOE must reach the Medicare contractor and be accepted within five calendar days after the election’s effective date. Medicare’s coverage manual explains acceptance in practical terms: the notice has not been returned to the hospice for correction. A transmission receipt and an accepted notice can tell different stories.

The coverage manual gives an exact example. An October 1 election has a timely notice if the contractor accepts it on or before October 6. In its late-filing example, acceptance does not occur until October 10, and the provider is liable for October 1 through October 9. The unpaid period reaches back to the beginning of the election.

The claims-processing manual explains where those days appear in billing. Occurrence span code 77 identifies the noncovered period, and charges on the affected claim lines must be noncovered. For an insider, the useful comparison is the acceptance history against the dates the claim treats as payable.

The NOE uses type of bill 81A or 82A. An election-date correction pairs condition code D0 with occurrence code 56, which carries the original date. The corrected election date replaces it in Medicare’s system, but the NOE receipt date stays unchanged. That leaves a trail when the date on the election changes after the notice arrived.

The Common Working File, Medicare’s shared claims system, may post the election later than the contractor accepts it. The claims manual separates that posting date from timely filing. A screen showing a later posting date therefore needs the contractor’s receipt and acceptance history beside it.

What Is the Difference Between Hospice Discharge and Revocation?

Revocation is the patient’s or representative’s decision to end the hospice election. Discharge is the hospice’s action to end care under Medicare’s rules. The hospice cannot make the patient’s revocation decision for them.

Medicare bars routine discharge because a patient’s care becomes costly or inconvenient. The hospice reports a discharge so billing ends on that date. Calling the event a patient revocation when the hospice made the decision misrepresents who chose to end care.

Can You Back Date a Hospice Revocation?

No. The effective date cannot be earlier than the date the patient or representative makes the revocation. Medicare requires a signed written statement with the effective date. A verbal revocation does not satisfy that requirement.

How Many Times Can a Hospice Patient Transfer to Another Hospice?

A patient may change the designated hospice once in each election period. Changing hospices does not restart the patient’s benefit period.

The signed transfer record identifies both hospices and the effective date. The receiving hospice files a new notice, but the benefit period continues. Treating that notice as a restart would give the billing record a false history.

When Is a Hospice Notice of Termination or Revocation Due?

The hospice must submit a Notice of Termination or Revocation that the contractor accepts within five calendar days after the effective date of a live discharge or revocation, unless the hospice has already filed a final claim. Prompt notice matters because the patient resumes the Medicare coverage previously waived by the hospice election.

The ending date on the patient’s document, the notice and the final claim should tell the same story. The date a billing employee enters a termination is a different fact from when the patient actually revoked care.

Which Late Notice Problems Can Qualify for an Exception?

Medicare allows an exception when a documented circumstance beyond the hospice’s control prevents timely filing. Examples include disasters that extensively damage operations, Medicare system problems, and delayed certification notification or system access for a newly certified hospice.

A claimed system delay leaves its own trail. The claims manual describes errors that cannot be corrected until Medicare finishes processing the original notice. The submission and correction history can show whether the explanation matches what happened.

A KX modifier on the claim identifies an exception request and prompts the contractor to seek supporting documentation. The contractor’s approval is what permits payment for the affected days. A billing record that claims an exception should have the corresponding explanation and decision behind it.

When the Billing Date Gets Ahead of the Care

A false billing day can begin with a document that moves the start of care backward or misrepresents the patient’s choice. The civil complaints make those allegations concrete, while the payment model explains why the dates matter.

Routine home care pays by the day the patient is under the hospice’s care. Visits, care planning, supplies and drugs sit inside that payment. In its study of assisted living facilities, the HHS Office of Inspector General found longer hospice care and higher payments than in other settings. Its description of the incentive is direct:

That makes the start of the hospice’s responsibility a payment question. The election, admission and plan of care establish the context for the visits and the daily claim.

In their complaint against Good Shepherd Hospice, whistleblowers alleged that billing began before the admission nurse performed the admission:

The alleged gap put payment ahead of admission.

The complaint against Harmony Care Hospice alleged a problem with the patient’s choice itself:

A notice could reach Medicare on time while the patient’s choice behind it was allegedly invented. The signed form and the account of how it was obtained matter alongside the transmission history.

What the Patient Record and the Paid Claim Show Together

We connect the election and care records with the notice’s submission, correction and acceptance history, then the paid claim. A changed date or exception request has to be understood alongside who authorized it and what the company told Medicare.

The HHS Office of Inspector General used this kind of connected review in its 2016 report on general inpatient hospice billing. Reviewers examined election statements, certifications, assessments, care plans and services. They found stays with no evidence of an election or certification of terminal illness. An accepted notice cannot supply a missing patient election or physician certification.

For a hospice fraud case under the False Claims Act, we connect the false payment claim to what the company knew and why the misrepresentation mattered to payment. Instructions to change dates, explanations sent to the contractor and decisions to keep billing are part of that examination. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When You Know Why the Dates Changed

If you work in hospice intake, billing or compliance and know why the notice history and paid days disagree, speak with our whistleblower experts about why the dates changed. We work with you to build your strongest hospice whistleblower case around the patient’s election, the billed days and the decisions inside the business, and bring in hospice fraud whistleblower lawyers who know Medicare billing cases. We stay beside you throughout the case.