New CMS Requirement Guide CR6440 Dates of Service Beginning

Transcription

1 New CMS Requirement Guide CR6440 Dates of Service Beginning Providing quality software solutions, allowing care providers to focus on what matters most.

2 Requirements Meeting the Requirements of CMS CR6440 Effective Dates for Regulation CR6440 Dates for Billing Changes based on Dates of Service (DOS) on claim, Not based on when Claim Submitted: Optional for Dates of Service (DOS) beginning October 1, 2009 Mandatory for Dates of Service beginning January 1, 2010 Summary of General Changes Visit Units are billed in 15-minute increments Reporting of Therapy Visits (Physical, Speech and Occupational) Reporting of some Social Worker Phone Calls: Phone Calls necessary for Palliation and Management of Terminal Illness, Related Conditions as Described in Plan of Care Phone Calls Related to Providing/Coordinating Care to Patient, Family and Documented in Clinical Record Items Not Changing: Respite in Contract Facility by non-hospice staff General Inpatient Care When Recording any Visit or Social Worker Phone Call Time, providers should sum the time for each visit or call, rounding up to the nearest 15 minute increment Providers should not include travel time or documentation time in the time recorded for any visit or call. Summary of General Changes to the Claim - Consolo Claims will now include: Each Visit for Nursing, Social Work and Hospice Aide will be billed on a separate Revenue Code Line Each Visit Lists Time in 15-minute Increments / Units Required HCPCS / G-Codes: Nursing 55X G0154 / 15-min increments / Visit date Social Worker 56X G0155 / 15-min increments / Visit date Aide 57X G0156 / 15-min increments / Visit date Social Worker Phone Calls to Patient / Family 569 G0155 / 15-min increments / Call date Therapies (Physical / Occupational / Speech): Physical Therapy 42X G0151 / 15-min increments / Visit date Occupational 43X G0152 / 15-min increments / Visit date Speech-Language Therapy 44X G0153 / 15-min increments / Visit date 2

3 Clinical Time ENTERING CLINICAL TIME (Within the Patient Clinical Charting Screen) Clinical Time Entry is Completed at the Bottom of Clinical Documentation Enter Time in Military Format Medicare Regulation requires the entry of Time In and Time Out for every billable Medicare visit. * Indicator to count as a visit on Medicare Claims Effective Date / Date In / Date Out should all be the same unless the time being entered passes midnight See full list of Visit Types and Clinical Care Types on Next page 3 Continued on next page...

4 Time Type Tables Bereavement Coordination of Care E.C.F./Group Home * Fax Funeral/Memorial Home * Hospital * LPN/LVN On Call Notes Mail Phone Call to MD/DO Missed Visit * Nursing Home * Other Pain Assessment Phone Call Personal Care Home * Phone Call Physician's Order Physician's IDT Physician's VISIT PRN * RN On-Call Notes SNF * Phone Call SW * Therapy Visit VISIT TYPE Triage - After hours Phone Call Triage - During hours Phone Call * Indicator to count as a visit on Medicare Claims NOTE: The use of Visit Types and Clinical Care Types is defined internally, based on Hospice Team Policies and Procedures 4 CLINICAL CARE TYPE 2nd Shift Visit 3rd Shift Visit 48-Hour Visit Admission After Hours Visit Backup Weekend Visit Bereavement Group Bereavement Hourly Bereavement Visit Complex Visit Continuous Care Visit Discharge - Death Discharge - Alive Evaluation GIP Visit Initial Certification Introductory Visit No Charge On Call Admit On Call Discharge - Death On Call Evaluation On Call Discharge - Alive On Call Standby On Call Visit Phone Call PRN Visit Re-Admission Re-Certification Regular Visit Teaching/Educational

5 Social Work Phone Call Entry Social worker Phone Calls to patient/family are counted as visits (with Time):» Only when necessary for Palliation and Management of Terminal Illness, Related Conditions as described in Plan of Care» Only related to Providing/Coordinating Care to Patient, Family and Documented in Clinical Record (Choose Phone Call SW *) Phone call Time In and Time Out must be recorded. 5

6 Entering Therapist To Bill for Therapy Visits, Therapist need to be entered as users, and have appropriate role selected. 6

7 Therapy Frequency This is the Hospice Assignment page. Therapist may be assigned to patients with visit frequency 7

8 Therapy Visits For Therapist visits to count on the claim they must be entered by someone with a Therapy Role Select appropriate Therapy type Remember times must be recorded. 8

9 Chart Audit Report The chart audit report (a clinical report) may be run to verify, visits and time that will be captured on medicare claims Click to Sort by Chart Type to make verification easier. Billable Units are the # of 15 minute increments that will display on the claim * Visits and Phone Calls (for Social Work) as well as assessments will be counted on claims for nursing, social work, therapists, and hospice aides. 9

10 Claim Sample Newly required HCPCS Codes Billable Service Units are the # of 15 minute increments that will display on the claim 10