Page 1. I. QUESTIONS ABOUT HETs SYSTEM
|
|
- Derek Anthony
- 6 years ago
- Views:
Transcription
1 CMS Hospice-related Q&A s April 2011 This list is compiled from the CMS Hospice Center ( with questions and answers that were posted or updated in April, Each question is linked to the Q&A as posted on the CMS website. NHPCO will continue to gather Q&As as they are posted and provide the summary, by category, each month as a part of the NHPCO Regulatory Round-Up. I. QUESTIONS ABOUT HETs SYSTEM Published 04/15/ :24 PM Updated 04/19/ :01 PM Answer ID Will HETS 270/271 return the Hospice code for revocation reason, e.g., transfer, death, or revoked? CMS has discussed the possibility of returning the Hospice Revocation Code on future HETS 271 responses. In the meantime, if the Hospice care has been revoked (Hospice Revocation Code = 1, 2, or 3), then HETS 270/271 will return a Hospice termination date. If the final Hospice bill has not yet been received (Hospice Revocation Code = 0), then HETS 270/271 will not return a Hospice termination date. Refer to Section 7.13 of the HETS 270/271 Companion Guide for further explanation. Published 04/15/ :21 PM Updated 04/19/ :59 AM Answer ID Does CMS plan to modify the HETS 271 response to display either the benefit period number or the last three election periods regardless of date of activity similar to the Medicare legacy eligibility systems that use CWF? HETS 270/271 only returns 27 months worth of history because, prior to January 1, 2011, that was the timely claim filing timeframe. To handle any overlap that may occur with the 60-day hospice certification, HETS 270/271 will return the certification dates 60 days prior to the "from date" on the 270 request since this would represent the oldest relevant Hospice data required for the timely submission of a claim. Published 04/15/ :19 PM Updated 04/19/ :59 AM Answer ID Does HETS 270/271 plan to add the patient status and patient indicator to the Home Health Prospective Payment System (PPS) episode information (as returned by Medicare legacy eligibility systems like HIQA and HIQH)? Currently, if a beneficiary is in continuous Home Health or Hospice episodes with a provider, this is reported as a single benefit period. Because of Medicare's new face-to-face visit requirements, it is important for providers to know exactly which benefit period or episode the patient is in. Are there plans for HETS 270/271 to report these periods/episodes in the same manner as they are reported in HIQA and HIQH? Page 1
2 There are no current plans to update the way in which Home Health and Hospice periods are combined and returned in the HETS 271 response. There is, however, a future change request that will return up to the 10 most recent Home Health and Hospice certification and recertification dates which support the new face-to-face visit requirements. These dates will be reported in the same manner as they are in the legacy Medicare eligibility HUQA and HIQA systems. : Published 04/15/ :17 PM Updated 04/19/ :58 AM Answer ID Explain why HETS 270/271 does not display "all" previous Hospice benefits periods. All Hospice benefit periods that overlap the requested dates are returned by HETS 270/271 but are not organized in the same manner as the Medicare legacy eligibility systems that utilize CWF. In HETS 270/271, the Hospice benefit periods are logically combined into larger periods representing continuous hospice care under the same provider. Refer to section 7.13 of the HETS 270/271 Companion Guide for further explanation. : II. QUESTIONS ABOUT THE FACE TO FACE ENCOUNTER Published 11/19/ :49 AM Updated 04/29/ :42 PM Answer ID 9917 Does the physician's attestation on the narrative, which is part of the physician's certification and recertification of Medicare hospice patients, have to use the language from the regulation verbatim? We have not mandated that specific language be included in the physician's attestation. Any language under the physician's signature which attests that by signing, the physician confirms that he/she composed the narrative based on his/her review of the patient's medical record or, if applicable, his or her examination of the patient meets the attestation regulatory requirement at 42 CFR (3)(iii). III. QUESTIONS ABOUT CLAIMS AND RECORDING VISITS ON THE CLAIM FORM Published 11/03/ :35 AM Updated 04/29/ :42 PM Answer ID 9887 Change Request 6440 requires time reporting of most hospice visits on claims. How should hospice providers report the time for visits when the visit takes less than 15 minutes? All visits up to 15 minutes are reported as one 15-minute increment, regardless of the length of the visit. Visits longer than 15 minutes are rounded to the nearest 15 minute increment (up or down). For example, a 5 minute visit is counted as 1 15-minute Page 2
3 increment, a 20 minute visit is counted as 1 increment, and a 25 minute visit is counted as 2 increments. Published 11/19/ :45 AM Updated 04/29/ :41 PM Answer ID 9915 Change Request (CR) 6440 requires reporting of allowable social worker phone calls, and the length of the call. When a social worker makes phone calls related to the patient's care during the course of a visit with the patient or his/her family, should those calls be reported, or should they be counted as part of the visit? Phone calls made on behalf of a patient during the course of a visit with the patient or his family should not be reported on hospice claims. Only report phone calls that are not made during a reportable visit, and which meet the criteria given in CR 6440: "Only phone calls that are necessary to the palliation and management of the terminal illness and related conditions as described in the patient's plan of care (such as counseling or speaking with a patient's family or arranging for placement) should be reported. Report only social worker phone calls related to providing and / or coordinating care to the patient and family, and documented as such in the clinical records." Published 11/19/ :46 AM Updated 04/29/ :41 PM Answer ID 9916 Change Request (CR) 6440 requires reporting of the length of most hospice visits. Some providers have staff spend time documenting during the course of a visit. For example, those using electronic medical records may record patient data in the medical record as the patient is being assessed. Should this documentation time be backed out of the visit time reported when the documentation occurs during a visit? To clarify the instructions in CR 6440, documentation time (such as the updating of medical records) which occurs during, and as part of, an otherwise covered and billable visit to a patient can be included in the time reported for the visit. Documentation time which occurs outside the context of such a visit is not reportable. Published 02/13/ :56 AM Updated 04/21/ :00 PM Answer ID 8904 How are visits counted for continuous home care (CHC)? CHC visits are counted in the same manner as Routine Home Care visits. An example of counting CHC visits would be where a registered nurse provides 4 hours of care in the morning and returns later in the day to provide 4 more hours of care in the evening; 2 nursing visits would be counted. If 3 nurses (in 3 consecutive 8-hour shifts) and one aide provide 24 hrs of CHC in a 24 hour period, 3 nursing visits and 1 aide visit would be counted. (Revised) Page 3
4 Reference Published 02/13/ :59 AM Updated 04/21/ :00 PM Answer ID 8906 If a hospice only uses licensed nurses to provide care, how will the home health aide visits be counted? The information on the claims does not identify what type of service is being provided, but merely identifies the number of visits by care provider type. Therefore, the visits provided by a licensed nurse would be reported as nursing visits. In this situation, there would be no home health aide visits reported on the claim. Reference Published 02/13/ :11 AM Updated 04/21/ :00 PM Answer ID 8913 Are attending physician visits by a physician not employed by or under contract with a hospice included on the claims data? No. The physician visits on the hospice claims are for reasonable and necessary visits by the hospice medical director or a physician who is employed by or under contract with the hospice. This includes any services provided by the hospice medical director or physician who is serving as the patient s attending physician. Services provided by a physician not employed by or under contract with a hospice are submitted on Part B claims and as such do not fall under the requirements of change request (CR) (Revised) Reference: (Revised) Reference Published 02/13/ :13 AM Updated 04/21/ :00 PM Answer ID 8915 If a hospice patient is at a contracted nursing home receiving Routine Home Care or Continuous Home Care, are the nursing home staff s patient care visits to the patient also included? No the number of visits to be included on the claims form is the number of visits provided by the hospice staff. (Revised) Reference Published 02/13/ :23 AM Updated 04/21/ :00 PM Answer ID 8919 Will CMS provide sample claim forms reflecting the changes in transmittal 1494, change request (CR) 5567? CMS does not typically provide sample claim forms for billing instructions. Medicare Page 4
5 contractors have discretion to develop such samples as part of their provider education efforts. Regarding the specific instructions in Transmittal 1494, sample claim forms could be misleading. The instructions intentionally provide hospices with flexibility and discretion in reporting, in an effort to reduce provider burden. For instance, some hospice software vendors have asked whether weekly service reporting (revenue codes 55x, 56x and 57x) must be accompanied by weekly reporting of level of care days (revenue codes ). This is not required, but it would be accepted by Medicare systems if a provider chose to do so for their own administrative reasons. Similarly, Transmittal 1494 requires weekly reporting of service disciplines for each place of service. The place of service for each level of care is reported by hospices using Healthcare Common Procedure Coding System (HCPCS) codes Q5001-Q5009. Vendors have wondered whether this means the place of service HCPCS codes are required on all service lines. They are not, because Medicare can associate the individual services to the place of service by their associated dates. But if a hospice chose to report the HCPCS codes, it would be allowed. There are additional examples where hospices have discretion to choose among reporting options. Options not in conflict with the instructions in the transmittal are allowed. Such flexibility may be of value to hospice agencies in tailoring their response to the instructions to their own administrative processes. Published 02/13/ :24 AM Updated 04/21/ :00 PM Answer ID 8920 Hospices are required by Medicare instructions to submit claims on a monthly basis. Reporting of services in transmittal 1494 is weekly (Sunday-Saturday). How are hospices to report weeks that are split across two months? Hospices continue to be required to bill monthly. For the weekly service reporting, partial weeks may be reported consistent with the month being billed. That is, if the first 3 days in a week fall in one month and the last four in the next month, report a line for that week on the claim for the month that is ending, showing the date of the earliest service that precedes the month end and the number of visits that preceded the month end. Report a line for the same week on the claim for the following month, showing the date of the earliest service that follows the start of the month and the number of visits in the balance of that week. Published 02/13/ :26 AM Updated 04/21/ :00 PM Answer ID 8922 Transmittal 1494 says that if a beneficiary s residence changes to cause the Core- Based Statistical Area (CBSA) reported on the claim to also change, the CBSA applicable at the end of the billing period should be reported. In the past, some hospices have submitted more than one claim in a month, showing the applicable CBSA code on each claim. Why can this no longer be done? As the previous question noted, hospices have been subject to Medicare s monthly billing requirement for repetitive services for several years. So it was not appropriate in the past to submit more than one claim in a monthly billing period. Using the CBSA code at the Page 5
6 end of the billing period has been CMS guidance for these cases for some time, following the precedent set on claims for home health episodes. This is just the first time this guidance has been placed in the Medicare Claims Processing Manual. Published 02/13/ :28 AM Updated 04/21/ :00 PM Answer ID 8924 What will a hospice do if it receives additional information about discipline visits or physician visits after the claim for a given month of services has already been submitted? If a hospice receives late information about reportable visits for any reportable discipline other than physicians, it will adjust the previously submitted claim to add the required information that was omitted. If a hospice receives late information about separately billable physician visits, it may either adjust the previously submitted claim or submit a separate late charge claim (type of bill 815 or 825) for the visits. (Revised) Published 02/13/ :30 AM Updated 04/21/ :00 PM Answer ID 8926 How should hospices report charges on the service discipline line items on the claim? Should they be included in the total charge field for the claim? Hospices are to report charges as accurately as possible. Charges are required to provide supplementary information and because many provider billing systems cannot generate service lines on a claim without a charge amount. Medicare systems will move the submitted charge amounts to be non-covered charges, indicating on remittances that these charges are bundled into the per diem payments made on the level of care line items. Charges for all lines are included in the total charge for the claim. (Revised) Published 02/13/ :33 AM Updated 04/21/ :00 PM Answer ID 8929 What will happen if required data are missing from lines reporting visits on hospice claims? If revenue code lines reporting visits (revenue codes 55x, 56x or 57x) are received without units or charges, the claim will be returned to the provider. Please note that this is also true for the reporting of site of service Healthcare Common Procedure Coding System (HCPCS) codes on hospice level of care revenue code lines (revenue codes 651, 652, 655 and 656). Claims submitted without the site of service HCPCS codes are currently returned to the provider. Page 6
7 Published 02/13/ :53 AM Updated 04/21/ :59 PM Answer ID 8902 What constitutes a reasonable and necessary social worker visit? As noted in responses above, a reasonable and necessary patient care visit by a social worker is a visit that is reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patient s plan of care. Due to the nature of a social worker s functions, counseling or speaking with a patient s family or arranging for placement, would constitute a visit. (Revised) Published 02/13/ :58 AM Updated 04/21/ :59 PM Answer ID 8905 For hospice services, why are rounds not considered a patient care visit? Rounds are an administrative activity rather than a patient care activity. A visit provided during rounds would not be considered a patient care visit unless a patient required a physician s assessment and/or intervention during the visit. Rounds performed in a facility for the purposes of writing orders or any other non-patient care required services, do not count as visits. (Revised) Published 02/13/ :02 AM Updated 04/21/ :59 PM Answer ID 8909 For hospice claims, what is the reporting week? As noted in CR 5567, the reporting week begins on Sunday and ends on Saturday. The workweek is defined so as to ensure consistent reporting parameters. Published 02/13/ :04 AM Updated 04/21/ :59 PM Answer ID 8911 Do supervision, education and orientation of staff constitute a visit for hospice services? No. These do not constitute a patient care visit. (Revised) Published 02/13/ :12 AM Updated 04/21/ :59 PM Answer ID 8914 Do travel time and time in IDG meetings count as a visit for hospice services? Page 7
8 No, as these are not patient care activities, they do not count as a visit. (Revised) Published 02/13/ :14 AM Updated 04/21/ :59 PM Answer ID 8916 How accurate should the charges on the claims be for hospice services? The charges on the claims are to be as accurate as possible. At this time, the charges will be used for research purposes only. (Revised) Published 02/13/ :22 AM Updated 04/21/ :59 PM Answer ID 8918 How will the changes in Transmittal 1494, change request (CR) 5567, be handled in various claim formats (e.g. electronic 837I claims, PC ACE-PRO 32 submissions, Direct Data Entry, hard copy claims)? The billing instructions in Transmittal 1494 do not vary across claim formats. The revisions to the Medicare Claims Processing Manual, chapter 11, section 30.3 describe the data elements required to be submitted on the newly required lines that report nursing, home health aide (also known as hospice aide) and medical social worker visits to hospice patients. These data elements should be reported in accordance with the standards and general instructions that govern each claim format. Published 02/13/ :25 AM Updated 04/21/ :59 PM Answer ID 8921 How should hospices report weeks in which an admission or a discharge occurred and as a result services are not provided for an entire Sunday-Saturday week? Hospices should report admission or discharge weeks identically to other weeks on the claim, showing the number of visits provided during the Sunday-Saturday period. The number of visits in these partial weeks would likely be reduced due to the fact that fewer than 7 days were available to provide services, but the reporting requirements are the same as for full weeks of service. Published 02/13/ :27 AM Updated 04/21/ :59 PM Answer ID 8923 Hospice services have always been paid on a per diem basis? Does the weekly reporting of services change this? Page 8
9 No. Hospices continue to submit claim lines for each level of care they provide at each site of service. The units reported on these lines continue to represent days and Medicare s payment continues on a per diem basis. The additional lines on hospice claims reporting visits per week do not currently affect payment, but are for data collection purposes only. The charge information is for research purposes only.(revised) Published 02/13/ :31 AM Updated 04/21/ :59 PM Answer ID 8927 For hospice claims, in what order should the various lines on a monthly claim be sorted- by date or in revenue code order? Hospices have discretion regarding the sort order of the line items on their claims. Medicare systems will accept any sort order and re-sort the ideas as needed during processing. Published 02/13/ :32 AM Updated 04/21/ :59 PM Answer ID 8928 For hospice services, why did the reporting of visits also bring a new requirement for the admission date on claims to match the effective date of the hospice election? This requirement is not new. The instruction reading Enter the admission date, which must be the same date as the effective date of the hospice election or change of election was carried forward into the current Medicare Claims Processing Manual (Pub ) from the paper-based Hospice Manual (Pub. 21). It has been in place for more than a decade. (Revised) Published 05/07/ :56 AM Updated 04/21/ :59 PM Answer ID 9117 How should a hospice provider count visits when Respite Care is provided in a contract facility? At this time, when a hospice patient is receiving Respite Care in a contract inpatient facility, the hospice should only count the visits made by its employees. Respite care is given for up to 5 consecutive days when the patient s caregiver needs a break. IV. OTHER HOSPICE RELATED QUESTIONS Published 04/27/ :37 AM Updated 04/29/ :26 AM Answer ID Page 9
10 10602 How do you define continuum of care? Does this include acute hospitals, nursing homes, home health, community-based organizations? Are you expecting CBOs to coordinate across "all" settings? The nursing home discharge is a completely different set of client needs than a discharge home; could we focus on one discharge location? Yes, hospitals, nursing homes, home health, SNF, and hospice are all part of the continuum of care, and we expect CBOs to coordinate across all settings. Beneficiaries often experience multiple transitions following discharge from the hospital and therefore a CBO must follow that beneficiary across various settings if there is any hope of reducing avoidable admissions. Page 10
CMS CR 6440: Additional Documentation on Hospice Claims Related Q&A s
CMS CR 6440: Additional Documentation on Hospice Claims Related Q&A s ID# 8901 - Published 02/13/2008 Updated 04/09/2010 What constitutes a patient care visit that is reasonable and necessary? A reasonable
More informationMedicare Claims Processing Manual Chapter 11 - Processing Hospice Claims
Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims Transmittals for Chapter 11 Table of Contents (Rev. 3326, 08-14-15) (Rev. 3378, 10-16-15) 10 - Overview 10.1 - Hospice Pre-Election
More informationReference Guide for Hospice Medicaid Services
Reference Guide for Hospice Medicaid Services for Florida s Statewide Medicaid Managed Care Plans (MMA & LTC) This reference guide is intended to provide general hospice information on Florida Medicaid.
More informationTacking The New Requirements: NOEs, NOTRs & Designation of the Attending Physician Subscriber Webinar This Round of Changes Let s Get Straight On History & intent Exactly what the new regulatory language
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2867 Date: February 5, 2014
CS anual System Pub 100-04 edicare Claims Processing Department of Health & Human Services (DHHS) Centers for edicare & edicaid Services (CS) Transmittal 2867 Date: February 5, 2014 Change Request 8569
More information08-16 FORM CMS
08-16 FORM CMS-2540-10 4110.1 4110 WORKSHEET S-8 - SNF-BASED HOSPICE IDENTIFICATION DATA In accordance with 42 CFR 418.310, hospice providers of service participating in the Medicare program are required
More informationPalmetto GBA Hospice Coalition Questions August 7, 2001
Palmetto GBA Hospice Coalition Questions August 7, 2001 1. How should billing be handled when the initial certification is provided outside of the 2 weeks before and 2 days after time frame? For example,
More informationState of California Health and Human Services Agency Department of Health Care Services
State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS Director EDMUND G. BROWN JR. Governor DATE: OCTOBER 28, 2013 ALL PLAN LETTER 13-014 SUPERSEDES ALL PLAN
More informationNATIONAL ASSOCIATION FOR HOME CARE & HOSPICE/ HOSPICE ASSOCIATION OF AMERICA
NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE/ HOSPICE ASSOCIATION OF AMERICA ADDITIONAL DATA REPORTING REQUIREMENTS FOR HOSPICE CLAIMS Comparison of CMS Proposed and Final Requirements Change Request 8358/Transmittal
More informationMedicare Hospice Billing 2015 & Beyond!
Medicare Hospice Billing 2015 & Beyond! Presented By: Melinda A. Gaboury, CEO Healthcare Provider Solutions, Inc. Sequential Claim Billing The NOE must be in S/LOC P B9997 prior to submitting the first
More informationHOSPICE TARGETED PROBE & EDUCATE Melinda A. Gaboury, COS C Healthcare Provider Solutions, Inc.
HOSPICE TARGETED PROBE & EDUCATE Melinda A. Gaboury, COS C Healthcare Provider Solutions, Inc. www.targetedprobe&educate.com Targeted Probe and Educate October 1, 2017 Targets providers based on data Can
More informationSTATE HOSPICE ORGANIZATION AND PALMETTO GBA COALITION MEETING SUMMARY
STATE HOSPICE ORGANIZATION AND PALMETTO GBA COALITION MEETING SUMMARY For meeting held on August 19, 2010 Included in this report: NCLOS audits update on status Various other audit types (ZPIC) Palmetto
More information06-01 FORM HCFA WORKSHEET S - HOME HEALTH AGENCY COST REPORT The intermediary indicates in the appropriate box whether this is the
06-01 FORM HCFA-1728-94 3204 3203. WORKSHEET S - HOME HEALTH AGENCY COST REPORT The intermediary indicates in the appropriate box whether this is the initial cost report (first cost report filed for the
More informationPhysician Estimate of Length of Services
Physician Estimate of Length of Services Can the physician estimate of length of services be longer than 60 days? The physician estimate of length of service can be longer than 60 days. This estimate is
More informationMedicare General Information, Eligibility, and Entitlement
Medicare General Information, Eligibility, and Entitlement Chapter 4 - Physician Certification and Recertification of Services Transmittals for Chapter 4 Table of Contents (Rev. 50, 12-21-07) 10 - Certification
More informationMedicare Part A Update
Medicare Part A Update Jennifer Bogenrief, JD Manager, Regulatory Affairs AOTA AOTA Specialty Conference: Effective Documentation Friday, September 12, 2014 1 Topics Medicare Therapy Documentation Requirements
More informationOctober Hospice Fundamentals All Rights Reserved 1. ABNs: The Why, The What & The When. The Plan
ABNs: The Why, The What & The When Subscriber Webinar The Plan CMS Benefit Notices Initiative The Advance Beneficiary Notice of Noncoverage (ABN) The Uses: Statutory & Voluntary The Form The Difficulties
More informationFY 2014 Changes to Medicare Inpatient Admission and Reimbursement Standards: CMS s Two Midnight Rule and the Revised Part A to Part B Rebilling Policy
FY 2014 Changes to Medicare Inpatient Admission and Reimbursement Standards: CMS s Two Midnight Rule and the Revised Part A to Part B Rebilling Policy Mark Polston King & Spalding In Fiscal Year 2014,
More informationChapter 11 Section 4. Hospice Reimbursement - Guidelines For Payment Of Designated Levels Of Care
Hospice Chapter 11 Section 4 Hospice Reimbursement - Guidelines For Payment Of Designated Levels Of Care Issue Date: February 6, 1995 Authority: 32 CFR 199.14(g) Revision: C-6, October 20, 2017 1.0 APPLICABILITY
More informationRESPITE CARE LEGACY HOSPICE
RESPITE CARE LEGACY HOSPICE THE BASICS OF RESPITE CARE WHAT IS RESPITE? Short-term inpatient care provided only when necessary to relieve the family members or other persons caring for the individual at
More informationTable of Contents. 1.0 Description of the Procedure, Product, or Service Definitions Hospice Terminal illness...
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Hospice... 1 1.1.2 Terminal illness... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1
More informationChapter 11 Section 3. Hospice Reimbursement - Conditions For Coverage
Hospice Chapter 11 Section 3 Issue Date: February 6, 1995 Authority: 32 CFR 199.4(e)(19) 1.0 APPLICABILITY This policy is mandatory for reimbursement of services provided by either network or nonnetwork
More informationHaving the Difficult Conversation: We need to Discharge You from Hospice
Having the Difficult Conversation: We need to Discharge You from Hospice Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care OBJECTIVES Identify the regulatory requirements
More informationAudio Title: Revised and Clarified Place of Service (POS) Coding Instructions Audio Date: 6/3/2015 Run Time: 16:03 Minutes ICN:
Audio Title: Revised and Clarified Place of Service (POS) Coding Instructions Audio Date: 6/3/2015 Run Time: 16:03 Minutes ICN: 909207 Welcome to Medicare Learning Network Podcasts at the Centers for Medicare
More informationFY2018 Hospice Wage Index Final Rule
FY2018 Hospice Wage Index Final Rule To: NHPCO Provider Members From: NHPCO Health Policy Team Date: August 2, 2017 Summary at a Glance On August 1, 2017, the Federal Register posted the FY2018 Hospice
More informationMedical Review: Past, Present and Future
Medical Review: Past, Present and Future HPCAI Fall Conference Annette Lee of Provider Insights, Inc. 11/5/2013 1 Progressive Corrective Action (PCA) Process designed by CMS, ensures a logical, fair methodology
More informationCMS OASIS Q&As: CATEGORY 2 - COMPREHENSIVE ASSESSMENT
CMS OASIS Q&As: CATEGORY 2 - COMPREHENSIVE ASSESSMENT Q1. When are we required to collect OASIS? [Q&A EDITED 06/14] A1. The Condition of Participation (CoP) published in January 1999 requires a comprehensive
More information4/17/2017 OBJECTIVES FEDERAL REQUIREMENTS. Having the Difficult Conversation: We need to Discharge You from Hospice
Having the Difficult Conversation: We need to Discharge You from Hospice Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care OBJECTIVES Identify the regulatory requirements
More informationPalmetto GBA Hospice Coalition Questions
Palmetto GBA Hospice Coalition Questions November 1, 1999 Billing/Reimbursement/FISS 1. The hospice medical director fails to sign a patient's recertification of terminal prognosis in a timely fashion.
More informationSame Day/Same Service Policy, Professional
Same Day/Same Service Policy, Professional Policy Number 2018R0002D Annual Approval Date 7/11/2018 Approved By REIMBURSEMENT POLICY CMS-1500 Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT
More informationChapter 11 Section 4. Hospice Reimbursement - Guidelines For Payment Of Designated Levels Of Care
Hospice Chapter 11 Section 4 Hospice Reimbursement - Guidelines For Payment Of Designated Levels Of Care Issue Date: February 6, 1995 Authority: 32 CFR 199.14(g) Revision: 1.0 APPLICABILITY This policy
More informationPECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011
PECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011 PRESENTED BY ALVA S. BAKER, MD, CMD Maine Medical Directors Association Faculty Disclosures: Dr. Baker has disclosed that he has no relevant
More informationhospic Hospice Care 1 Hospice care is a medical multidisciplinary care designed to meet the unique needs of terminally ill individuals.
Hospice Care 1 Hospice care is a medical multidisciplinary care designed to meet the unique needs of terminally ill individuals. Hospice care is used to alleviate pain and suffering, and treat symptoms
More informationAdministrative Guide. KanCare Program Chapter 11: Hospice. Physician, Health Care Professional, Facility and Ancillary. UHCCommunityPlan.
KanCare Program Physician, Health Care Professional, Facility and Ancillary Administrative Guide Doc#: PCA-1-003044_06202016 UHCCommunityPlan.com Welcome to UnitedHealthcare This administrative guide is
More informationApril 8, 2013 RE: CMS 3267 P. Dear Administrator Tavenner,
April 8, 2013 Marilyn Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 3267 P P.O. Box 8010 Baltimore, MD 21244 8010 RE: CMS 3267
More informationCATEGORY 4 - OASIS DATA SET: FORMS and ITEMS. Category 4A - General OASIS forms questions.
Q1. [Q&A RETIRED 09/09; Outdated] CATEGORY 4 - OASIS DATA SET: FORMS and ITEMS Category 4A - General OASIS forms questions. Q2. When integrating the OASIS data items into an HHA's assessment system, can
More informationThe Medicare Hospice Program: New Billing Requirements & Hot Topics from Your Medicare New England Home Care & Hospice Conference and Trade Show
The Medicare Program: New Billing Requirements & Hot Topics from Your Medicare New England Home Care & Conference and Trade Show Add doc ctrl no. Today s Presenters Corrinne Ball, RN, CPC, CAC, CACO Provider
More informationMedicare Claims Processing Manual Chapter 10 - Home Health Agency Billing
Medicare Claims Processing Manual Chapter 10 - Home Health Agency Billing Table of Contents (Rev. 2209 05-06-11) (Rev. 2249 07-01-11) Transmittals for Chapter 10 Crosswalk to Old Manual 10 - General Guidelines
More informationCare Plan Oversight Services and Physician Services for Certification
Education Makes the Difference Care Plan Oversight Services and Physician Services for Certification and Recertification of Medicare-Covered Home Health Services A CMS CONTRACTED INTERMEDIARY CARRIER The
More informationHospice Continuous Home Care LEGACY HOSPICE
Hospice Continuous Home Care LEGACY HOSPICE The Basics CONTINUOUS HOME CARE OF THE HOSPICE PATIENT What is Continuous Home Care? A day on which an individual who has elected to receive hospice care is
More informationChanges to Medicare Inpatient Admission and Reimbursement Standards: CMS s Two Midnight Rule and the Revised Part A to Part B Rebilling Policy
Changes to Medicare Inpatient Admission and Reimbursement Standards: CMS s Two Midnight Rule and the Revised Part A to Part B Rebilling Policy Mark Polston King & Spalding In Fiscal Year 2014, the Centers
More informationState Operations Manual. Appendix M - Guidance to Surveyors: Hospice - (Rev. 1, )
State Operations Manual Appendix M - Guidance to Surveyors: Hospice - (Rev. 1, 05-21-04) Part I Investigative Procedures I - Introduction A - Initial Certification Surveys B - Recertification Survey of
More informationMLN Matters Number: MM6699 Related Change Request (CR) #: 6699
News Flash Medicare will cover immunizations for H1N1 influenza also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their
More informationHome Health & HP Provider Relations
Home Health & Hospice HP Provider Relations October 2010 Agenda Session Objectives Home Health Benefit Coverage Billing Overhead Multiple Visits Most Common Denials Hospice Benefit Coverage Election/Revocation/Discharge
More informationOutpatient Observation Services
Outpatient Observation Services Presented by: Gina Hobert, MBA, CHC, CPC-I, CPMA, CEMC, CRC Sr. Manager, Baker Newman Noyes Definition MCR Benefit Policy Manual, CMS 100-02, Chapter 6, 20.6 A. Outpatient
More informationDear Physicians and Practitioners,
Dear Physicians and Practitioners, Effective January 1, 2011, due to new provisions mandated by passage of the Affordable Care Act, there are new statutory requirements regarding face-to-face encounters
More informationATTENDING PHYSICIAN ORDERS AND COVERAGE
ATTENDING PHYSICIAN ORDERS AND COVERAGE Patient s Choice of Attending Physician: CMS defines the hospice Attending Physician as either: a doctor of medicine or osteopathy legally authorized to practice
More informationUsing the Hospice PEPPER to Support Auditing and Monitoring Efforts: Session 1
Using the Hospice PEPPER to Support Auditing and Monitoring Efforts: Session 1 March, 2016 Kimberly Hrehor Agenda Session 1: History and basics of PEPPER PEPPER target areas Percents and percentiles Comparison
More informationGeneral Inpatient Level of Care: Managing Risks
General Inpatient Level of Care: Managing Risks THE CAROLINAS CENTER, 2015 1 Presenter Annette Kiser, MSN, RN, NE-BC Director of Quality & Compliance The Carolinas Center akiser@cchospice.org THE CAROLINAS
More informationConditions of Participation for Hospice Programs
Conditions of Participation for Hospice Programs Code of Federal Regulations --- Title 42, Volume 2, Parts 400 to 429 TITLE 42 PUBLIC HEALTH CHAPTER IV CENTERS FOR MEDICARE AND MEDICAID SERVICES DEPARTMENT
More informationThe Medicare Regulations for Hospice Care, Including the Conditions of Participation for Hospice Care 42 CFR418
The Medicare Regulations for Hospice Care, Including the Conditions of Participation for Hospice Care 42 CFR418 Current as of July 29, 2011 Hospice Provisions from: Balanced Budget Act of 1997 Balanced
More informationInsight into Hospice and PACE
Insight into Hospice and PACE Defining Hospice Care A form of palliative care designed to provide medical, spiritual and psychological care to individuals facing a life limiting illness. Focuses on caring,
More informationFY 2017 Hospice Proposed Rule. Hospice Regulatory Review May Webinar Agenda. Hospice Regulatory Review
Hospice Regulatory Review May 2016 Presented by: Deanna Loftus, Director of Regulatory Compliance Liz Silva, Director of Hospice Webinar Agenda CY 2017 Proposed Rule o New Payment Rates o Diagnosis Code
More informationHCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans
HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN Kelly Priegnitz # Chris Puri # Kim Looney Post Acute Provider Specific Sections from 2012-2015 OIG Work Plans I. NURSING HOMES
More informationHospice Discharges. Legacy Hospice
Hospice Discharges Legacy Hospice Live Discharges Once a Medicare beneficiary elects the hospice benefit, hospice may not automatically or routinely d/c the beneficiary at it s discretion, even if the
More information05-11 FORM CMS (Cont.)
05-11 FORM CMS-2540-10 4100 4100. GENERAL The Paperwork Reduction Act (PRA) of 1995 requires that the private sector be informed as to why information is collected and what the information is used for
More informationChronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky
Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Agenda Chronic Care Management (CCM) History Define Requirements
More informationNHPCO Regulatory Recap for Activity from August 2011 Volume 1, Issue No.8
NHPCO Regulatory Recap for Activity from August 2011 Volume 1, Issue No.8 To: NHPCO Membership From: NHPCO Regulatory Team IN THIS ISSUE: CMS Help Prevent Fraud Campaign CMS Provider Compliance Group Outreach
More informationOASIS ITEM ITEM INTENT TIME POINTS ITEM(S) COMPLETED RESPONSE SPECIFIC INSTRUCTIONS DATA SOURCES / RESOURCES
(M0080) Discipline of Person Completing Assessment: 1-RN 2-PT 3-SLP/ST 4-OT Specifies the discipline of the clinician completing the comprehensive assessment during an actual visit to the patient s home
More information2015 National Training Program. History of Modern Hospice. Hospice Legislative History. Medicare s Coverage of Hospice Services
2015 National Training Program Medicare s Coverage of Hospice Services For Those Who Counsel People With Medicare July 2015 History of Modern Hospice 1948 English physician Dame Cicely Saunders works with
More informationInpatient orders and Physician Certification MUST BE authenticated PRIOR to discharge No EXCEPTIONS.
2 Midnight Rule for InPatient Admission On August 2, 2013 the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS- 1599-F) updating Medicare payment policies which modifies and clarifies
More information8/28/2014. Compliance and Practical Challenges When Using Scribes: Just What the Doctor Ordered? Objectives of the Presentation
Compliance and Practical Challenges When Using Scribes: Just What the Doctor Ordered? Jerry Williamson MD. MJ. CHC. LHRM Objectives of the Presentation Definition of a Scribe Duties of a Scribe Regulatory
More informationHospice Billing: Two Tier and SIA Payments
Billing: Two Tier and SIA Payments January 2016 1787_1215 Today s Presenters Corrinne Ball, RN, CPC, CAC, CACO Provider Outreach and Education Consultant Email: J6.provider.training@anthem.com 2 Disclaimer
More informationApril Hospice Fundamentals All Rights Reserved 1. The Certification/ Recertification Process: No Room for Error. What You Will Learn Today
The Certification/ Recertification Process: No Room for Error Subscriber Webinar What You Will Learn Today Regulatory requirements Election of the Medicare Hospice Benefit Certification Recertification
More informationThe Medicare Admissions Process and Strategies for Success. Your Speakers
The Medicare Admissions Process and Strategies for Success Leading Age Michigan 2014 Annual Leadership Institute Thursday, August 14, 2014 10:45 am 11:45 am 1 Your Speakers Betsy Anderson, President FR&R
More informationMISSOURI. Downloaded January 2011
MISSOURI Downloaded January 2011 19 CSR 30-81.010 General Certification Requirements PURPOSE: This rule sets forth application procedures and general certification requirements for nursing facilities certified
More informationMedicare Home Health Prospective Payment System
Medicare Home Health Prospective Payment System Payment Rule Brief Final Rule Program Year: CY 2013 Overview On November 8, 2012, the Centers for Medicare and Medicaid Services (CMS) officially released
More informationMarch Hospice Fundamentals All Rights Reserved 1. Preventing & Managing Unplanned Hospitalizations
Preventing & Managing Unplanned Hospitalizations Subscriber Webinar Today s Plan Importance of minimizing unplanned hospitalizations Preventing unplanned hospitalizations Managing unplanned hospitalizations
More informationJaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC Disclaimer
Advanced Evaluation and Management More than a roll of the dice? History Exam Medical Decision Making Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practieintegrity.com
More informationMedicare Home Health & Hospice Changes
A webinar for Medicare Home Health & Hospice Changes Physician Face-to-Face Encounters M. Aaron Little, CPA Senior Managing Consultant mlittle@bkd.com LeadingAge Information Available Peter Notarstefano,
More informationConnecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Hospice Agenda Overview Forms Fee Schedule/Reimbursement
More informationELIGIBILITY & CERTIFICATION THE CONTINUING SAGA
1 ELIGIBILITY & CERTIFICATION THE CONTINUING SAGA Hospice Fundamentals Charlene Ross, MSN, MBA, RN Consultant / Educator 2 What You Will Learn Today The regulatory requirements of certification, recertification
More informationTime Span Codes. Approved By 5/11/2016
Policy Number Annual Approval Date 5/11/2016 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare Medicare Advantage Plans offered
More informationThe Concerns. Hospice Care in The Nursing Home NHPCO MLC All Rights Reserved 1.
Hospice Care in The Nursing Home Navigating The Regulatory Challenges Roseanne Berry, MSN, RN Consultant/Educator R&C Healthcare Solutions & Hospice Fundamentals 480 650 5604 roseanne@rchealthcaresolutions.com
More informationMeeting the CMS July 1 Deadline to Report Hospice Visits/Charges: Are You Ready?
National Association for Home Care & Hospice presents Meeting the CMS July 1 Deadline to Report Hospice Visits/Charges: Are You Ready? Audio Conference Wednesday, May 28, 2008 2:30 PM 4:00 PM Eastern 1:30
More informationNavigating Therapy Compliance Requirements Across The Continuum. Objectives. Therapy is Occurring Everywhere!
Navigating Therapy Compliance Requirements Across The Continuum Kay Hashagen, PT, MBA, RAC-CT Senior Consultant LW Consulting, Inc. Catherine Gill, MS, PT, MHA Director of Quality and Support Services;
More informationAdvanced Evaluation and. AAPC Regional Conference Chicago 10/27/12
Advanced Evaluation and Management AAPC Regional Conference Chicago 10/27/12 Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practiceintegrity.com Disclaimer Information
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 04/15/12 REPLACED: CHAPTER 24: HOSPICE SECTION 24.3: COVERED SERVICES PAGE(S) 5 COVERED SERVICES
COVERED SERVICES Hospice care includes services necessary to meet the needs of the recipient as related to the terminal illness and related conditions. Core Services (Core services) must routinely be provided
More informationPO Box 350 Willimantic, Connecticut (860) Connecticut Ave, NW Suite 709 Washington, DC (202)
PO Box 350 Willimantic, Connecticut 06226 (860)456-7790 1025 Connecticut Ave, NW Suite 709 Washington, DC 20036 (202)293-5760 Se habla español Produced under a grant from the Connecticut State Department
More informationCHANGE M OCTOBER 23, CHAPTER 5 Section 4, pages 1 and 2 Section 4, pages 1 and 2
CHANGE 149 6010.58-M OCTOBER 23, 2017 REMOVE PAGE(S) INSERT PAGE(S) CHAPTER 5 Section 4, pages 1 and 2 Section 4, pages 1 and 2 CHAPTER 7 Section 2, pages 3 and 4 Section 2, pages 3 and 4 CHAPTER 13 Section
More informationCMS -1599F. The 2 Midnight Rule Effective October 1, 2013
Joseph Nitti, M.D. Medical Director/Physician Advisor Continuum of Care Dept. Morristown Medical Center 973-971-4004 CMS -1599F The 2 Midnight Rule Effective October 1, 2013 Determination of Inpatient
More informationMedicare Noncoverage Notices
March 2014 This job aid is intended to assist home health and hospice clinicians in: Understanding and complying with regulations for issuing required Medicare notices at the time of termination and change
More informationThe Monthly Publication of the National Hospice and Palliative Care Organization
The Monthly Publication of the National Hospice and Palliative Care Organization Print-friendly PDF From September 2012 Issue A Hospice Provider s Guide to Live Discharges By Jennifer Kennedy, MA, BSN,
More informationNational Hospice and Palliative Care OrganizatioN. Facts AND Figures. Hospice Care in America. NHPCO Facts & Figures edition
National Hospice and Palliative Care OrganizatioN Facts AND Figures Hospice Care in America 2017 Edition NHPCO Facts & Figures - 2017 edition Table of Contents 2 Introduction 2 About this report 2 What
More information(f) Department means the New Hampshire department of health and human services.
Adopted Rule 6/16/10. Effective: 7/1/10 1 Adopt He-W 544.01 544.16, cited and to read as follows: CHAPTER He-W 500 MEDICAL ASSISTANCE PART He-W 544 HOSPICE SERVICES He-W 544.01 Definitions. (a) Agent means
More informationHOSPICE FINAL RULE by SHARON HARDER, President - C3 Advisors, LLC
FAQ: THE 2018 HOSPICE FINAL RULE 1 FAQ FREQUENTLY ASKED QUESTIONS ABOUT The 2018 HOSPICE FINAL RULE by SHARON HARDER, President - C3 Advisors, LLC and BETH NOYCE, RN, BSJMC, HCS-H, HCS-D, COS-C, Consultant
More informationSubmission #1. Short Description: Medicare Payment to HOPDs, Section 603 of BiBA 2015
Submission #1 Medicare Payment to HOPDs, Section 603 of BiBA 2015 Within the span of a week, Section 603 of the Bipartisan Budget Act of 2015 was enacted. It included a significant policy/payment change
More informationMississippi Medicaid Hospice Services Provider Manual
Mississippi Medicaid Hospice Services Provider Manual Effective: January 2011 Revised: January 2017 Table of Contents I. Introduction II. Frequently Used Terms III. Getting Started Helpful Tips A. Before
More informationRelease Notes - Version (DRAFT) Release Date: 09/03/2011
Release Notes - Version 3.0.8 (DRAFT) Release Date: 09/03/2011 Please Sync all Off-Line Charting Prior to the Release Human Resources Tracking - Enhanced Human Resources Related Links have been added to
More information10/22/2012. Discharge, Revocation and Transfer: Process, ABN and Appeals. Discharge the regulations. Objectives for Today s Session
Discharge, Revocation and Transfer: Process, ABN and Appeals Jennifer Kennedy, MA, BSN, CHC, LNC National and Palliative Care Organization Patricia Smith Putzbach, RN, BSN, MBA, CHPN Life Choice Discharge
More informationChapter 14: Long Term Care
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S P R O V I D E R M A N U A L Chapter 14: Long Term Care Library Reference Number: PRPR10004 14-1 Chapter 14 Indiana Health Coverage Programs Provider
More informationMedicare Home Health Prospective Payment System (HHPPS) Calendar Year (CY) 2013 Final Rule
Last updated 11/13/12 Contact: Advocacy@apta.org Medicare Home Health Prospective Payment System (HHPPS) Calendar Year (CY) 2013 Final Rule Introduction COMPREHENSIVE SUMMARY On November 2, 2012, the Centers
More informationProviding and Billing Medicare for Chronic Care Management Services
Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) Updated March 2018 No portion of this white paper may be used or duplicated
More informationThank you for joining us!
Thank you for joining us! We will start at 1 p.m. CT. You will hear silence until the session begins. Handout: Available at PEPPERresources.org in the Hospice Training and Resources section. A recording
More informationMEDICARE PROGRAM; FY 2014 HOSPICE WAGE INDEX AND PAYMENT RATE UPDATE; HOSPICE QUALITY REPORTING REQUIREMENTS; AND UPDATES ON PAYMENT REFORM SUMMARY
MEDICARE PROGRAM; FY 2014 HOSPICE WAGE INDEX AND PAYMENT RATE UPDATE; HOSPICE QUALITY REPORTING REQUIREMENTS; AND UPDATES ON PAYMENT REFORM SUMMARY On April 29, 2013, the Centers for Medicare & Medicaid
More informationMEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW OHA Finance/PFS Webinar Series. May 10, 2016
MEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW 2016 OHA Finance/PFS Webinar Series May 10, 2016 Spring is Medicare PPS Proposed Rules Season Inpatient Hospital Long-Term Acute Care Hospital Inpatient Rehabilitation
More informationThe President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary
Current Law The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform Summary Home Health Agencies Under current law, beneficiaries who are generally restricted to
More informationCAHABA GOVERNMENT BENEFIT ADMINISTRATORS (GBA) PROVIDER-BASED ATTESTATION STATEMENT. Main Provider Medicare Provider Number:
Main Provider Information: Main Provider Medicare Provider Number: Main Provider Legal Business Name: Main Provider Doing Business As Name: Main Provider s Address: Attestation Contact Name (please print):
More informationOIG Hospice Risk Areas With Footnotes
Moreover, the compliance programs should address the ramifications of failing to cease and correct any conduct criticized in a Special Fraud Alert, if applicable to hospices, or to take reasonable action
More informationHospital Refresher Workshop. Presented by The Department of Social Services & HP Enterprise Services
Hospital Refresher Workshop Presented by The Department of Social Services & HP Enterprise Services 1 Training Topics Provider Bulletins Outpatient Claim Billing Changes Explanation of Benefit Codes Web
More information