Noting improper use of the modifier KX and the additional documentation request (ADR) process, CGS is reminding agencies in its states of the rules around exception requests for late NOAs. CGS is a Medicare Administrative Contractor servicing agencies in 15 states.
NOAs are expected to be submitted and approved with five calendar days of the admission date.
There are four circumstances that may qualify for an exception, according to CMS policies:
- Fires, floods, earthquakes or other unusual events that inflict extensive damage to the provider's ability to operate
- An event that produces a data filing problem due to a CMS or MAC system issue that is beyond the provider's control
- A newly Medicare-certified provider that is notified of their certification after the Medicare certification date or is awaiting its user ID from the MAC
- Other circumstances determined by the MAC or CMS to be beyond the provider's control
CGS notes that, if an NOA is untimely due to one of the circumstances above, agencies should report the following information on the associated claim for payment (i.e., TOB 329 (home health) or TOB 8X1, 8X2, 8X3 or 8X4 (hospice)):
- Modifier KX (indicates you are requesting an exception for the untimely NOA/NOE)
- REMARKS field (FISS Page 04) – Clearly indicate all the circumstances and time frames that support the exception request.