What is the hospice Notice of Election (NOE)?

The Notice of Election (NOE) is the electronic filing every hospice submits to Medicare (through the MAC) to establish that a beneficiary has elected hospice. The NOE is different from the election statement itself and has its own strict timing requirements.

By Goodwin Hospice Academy Editorial Team· Published February 16, 2026·Last reviewed February 16, 2026· 5 min read

NOE, in one sentence

The NOE is the electronic MAC filing the hospice submits within 5 calendar days of the effective date of election, notifying Medicare that the beneficiary has elected the hospice benefit.

Timing

The NOE must be filed within 5 calendar days of the effective date of election. Filings beyond 5 days are considered "untimely" and are subject to a specific payment penalty (per-day non-covered days) unless the hospice qualifies for an exception.

Exceptions

CMS grants specific exception categories for timely-filing failures (e.g., Medicare system outages, natural disasters, MAC-caused delays). Exception requests must be documented and submitted per the current CMS guidance.

How NOE differs from election statement

The election statement is the paper (or electronic) document the beneficiary signs. The NOE is the electronic transaction the hospice sends to Medicare via the MAC. Both are required.

Frequently asked questions

What triggers the NOE penalty?

Any NOE filed later than 5 calendar days after the effective date of election. The penalty converts each late day into a non-covered day (the hospice cannot bill for those days).

Can we recoup the non-covered days?

Only by successfully submitting an exception request under a recognized CMS exception category.

What is the NOTR?

The Notice of Termination or Revocation (NOTR) is filed by the hospice when the beneficiary revokes hospice, transfers to another hospice, or dies. NOTR must be filed within 5 calendar days of the effective date of revocation/discharge.

Sources & further reading

Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current CMS guidance.

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