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Electronic notice that opens a hospice benefit period with the MAC
The electronic notice a hospice submits to its Medicare Administrative Contractor within five calendar days of a patient's hospice election, opening the benefit period for billing; late NOEs create non-covered days.
The Notice of Election (NOE) is the electronic notice a hospice submits to its Medicare Administrative Contractor (MAC) to open a beneficiary's hospice benefit period in Medicare's systems. It must be submitted to, and accepted by, the MAC within 5 calendar days after the effective date of election [1].
The NOE (Type of Bill 8XA) records the beneficiary, the elected hospice, and the election effective date so the MAC can establish the benefit period in the Common Working File (CWF). Until that period is posted, subsequent hospice claims cannot be matched and paid. Under 42 CFR 418.24, the hospice must file the NOE within 5 calendar days after the effective date of the election statement [1]. "Timely-filed" means the NOE was submitted to and accepted by the MAC within that window — accepted meaning it was not returned to the provider for correction (RTP). When the NOE is not timely-filed, Medicare will not cover or pay for the days of hospice care from the election effective date to the date the NOE is submitted and accepted; those days are a provider liability and the hospice may not bill the beneficiary for them [2]. CMS illustrates this with an example: if election is October 1 and the NOE is not accepted until October 10, October 1 through October 9 are provider-liable days. Four exception circumstances can waive the penalty: fires, floods, earthquakes or similar events damaging operations; a CMS or MAC systems issue beyond the hospice's control; a newly Medicare-certified hospice awaiting its certification notice or user ID; and other circumstances CMS determines were beyond the hospice's control [1].
The 5-day NOE window is one of the few hospice billing rules where a purely clerical miss produces a permanent, unbillable revenue loss — the money is written off, not deferred, and it cannot be shifted to the patient. At the FY 2026 Routine Home Care rate of $230.83 per day for the first 60 days [3], a NOE accepted five days late on a single admission erases more than $1,150 in non-recoverable revenue. The exception process is narrow and documentation-heavy, making it a rare backstop rather than a reliable safety net. NOE acceptance — not just submission — is the operative tracking measure, because a NOE that is returned to provider (RTP) and re-keyed on day 6 is late even if the first attempt went out on day 2. A NOE returned to provider and resubmitted after day 5 produces provider-liable days identical to a NOE that was never filed on time.
You have 5 calendar days after the effective date of election, and the NOE must be accepted — not merely submitted — within that window [1].
Medicare will not pay for hospice days from the election date until the date the NOE is accepted, and those days become a provider liability. The hospice absorbs the loss and cannot bill the patient.
No; CMS expressly prohibits billing the beneficiary for days made non-covered by an untimely NOE.
No; timeliness is based on submission and acceptance by the MAC within 5 days, and CWF posting may occur later without affecting whether the NOE was timely.
Vitalis Care is the end-of-life care app that helps hospices deliver compassionate care — while staying on top of schedules, field operations, documentation, compliance, and reimbursement.
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