Notice of Termination/Revocation (NOTR)

The Notice of Termination/Revocation (NOTR) is the electronic notice a hospice files to close an open benefit period in Medicare's systems when a beneficiary revokes the benefit or is discharged alive. It is filed on Type of Bill 8XB within 5 calendar days of the effective date of the discharge or revocation, unless the hospice has already submitted a final claim ^[1].

Once an NOE opens a benefit period in the CWF, that period stays open until it is closed by either a final claim or a NOTR. When a beneficiary revokes hospice or is discharged alive and a final claim will not be filed promptly, the hospice submits a NOTR within 5 calendar days of the effective date of the revocation or discharge to close the period. If the final claim is filed first, it closes the period and a separate NOTR is unnecessary. Only the active billing hospice can submit the notice that closes its own election. Unlike the NOE, the NOTR is not tied to a payment penalty — there is no direct reimbursement reduction for filing it late. The consequence is downstream: an open, uncleared benefit period can block the next hospice from filing a timely NOE for the same beneficiary, because CWF will reject an overlapping election. In practice, the NOTR functions as the release mechanism that lets a transferring or re-electing patient move without stranding the receiving provider's NOE.

The NOTR is easy to under-prioritize precisely because it carries no dollar penalty, and that is where its cost is realized — externally and reputationally rather than internally. A hospice that habitually leaves periods open becomes the reason a downstream provider's NOE is late, and that downstream provider absorbs provider-liable days it did not cause. Treating the NOTR with the same 5-day clock discipline as the NOE — even though only one carries a payment consequence — is the defensible practice. Open periods not matched to an active census patient create a downstream liability that blocks the next hospice's NOE and distorts live-discharge tracking, both of which draw auditor attention.