Reason Code U5111

Description
This reason code is assigned to hospice 8XB or 8XD type of bills when the start date falls within a previously established hospice election period.

Or,

This reason code is assigned to hospice 8XB or 8XD type of bills in the following situations:

• An 8XB is submitted after a final claim has been processed with a discharge patient status code
• When a Notice of Transfer/Revocation (NOTR) is submitted (8XB), a revocation date and revocation indicator (1) will be posted on the Common Working File (CWF) election period screen. If a discharge claim is submitted in lieu of the NOTR, the claim will also post the revocation date and revocation indicator.
• An 8XB is submitted, but the start date does not fall within an established election period

Resolution
Before submitting an 8XB type of bill, check to see if a final (discharge) claim (8X4 type of bill) has been submitted with a discharge patient status code (01, 50 or 51). If a final claim has been submitted with a discharge patient status code, the 8XB does not need to be submitted.

• If the 8XB is in the Return to Provider (RTP) file (T B9997 status/location), do not press F9. You can suppress the view, as this does not need to be submitted.
• If an 8XB or 8XD is submitted, ensure that the “From” date on the claim matches the “Start” date of the hospice election period
• When there is no change in the provider number during the election, submit the start date of the election period as the “From” date on the NOTR
• If the beneficiary transferred to your hospice during the benefit period, the “From” date must match the “START DATE 2” on the benefit period that initiated the transfer
• If the revocation follows a change of ownership, the “From” date on the NOTR must match the “OWNER CHANGE” “Start” date on the benefit periods

Resource: MLN Matters® Article SE18007 — Recent and Upcoming Improvements in Hospice Billing and Claims Processing (PDF).