The Notice of Election (NOE) is more than a clinical administrative task; it is a critical financial trigger. In the hospice revenue cycle, the NOE serves as the formal notification to Medicare that an agency has assumed responsibility for a patient’s care. Failure to file this document within the mandatory window results in permanent, unrecoverable revenue loss.

The Standard for Timely Filing

Medicare regulations require that an NOE be filed within five calendar days after the beneficiary’s hospice admission date. For a filing to be considered legally “timely,” it must meet two specific criteria:

• Receipt Date: The NOE must be received by the Medicare contractor within five calendar days after the admission date.
• Processing Status: The NOE must successfully process and reach the final status/location P B9997.

The Cost of Non-Compliance

When an NOE is filed late, the financial consequences are immediate. Medicare will not reimburse the agency for the days of care provided from the date of admission until the date the NOE is finally submitted and accepted.

Consider this example of a late filing:

• Admission Date: May 1st
• NOE Receipt Date: May 10th
• The Result: The agency is responsible for the cost of care from May 1st through May 9th. These nine days are considered “non-covered” and represent a 100% loss of revenue for that period.

The “RTP” Trap: Resubmissions and Timeliness

One of the most common drivers of revenue loss is the Return to Provider (RTP) error. If an NOE is submitted within the five-day window but contains errors, it will be sent back for corrections.

It is critical to understand that the resubmission date becomes the new “receipt date” for timeliness purposes. Even if your initial attempt was on day two, if the corrected version isn’t accepted until day ten, the entire period remains non-covered. This is why “clean” initial submissions are just as important as “fast” submissions.

Operational Requirements for Late Filings

If an agency identifies that an NOE was filed untimely, the subsequent claim must be coded specifically to reflect the non-covered period. This is not optional; failure to code correctly can lead to claim rejections or audits.

• Occurrence Span Code (OSC) 77: This must be used on the claim to identify the specific dates that are non-covered due to the late NOE.
• Dual-Line Billing: The claim must be split into two distinct rows: one for the non-covered days (associated with OSC 77) and one for the covered days following the NOE acceptance.

Leadership Strategy: Moving to a 48-Hour Standard

To eliminate the risk of late filings, high-performing agencies do not aim for the five-day deadline. Instead, they implement an internal 48-hour submission rule.

By requiring NOEs to be filed within two days of admission, leadership creates a “buffer” to handle unexpected RTP errors or technical issues with the billing software. This proactive operating rhythm ensures that administrative delays never compromise the agency’s financial stability or the clinical team’s ability to focus on patient care.