PREPARING FOR THE 2016 HOSPICE PAYMENT CHANGES 12/15/2015. December 16, Mark Sharp Partner

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1 PREPARING FOR THE 2016 HOSPICE PAYMENT CHANGES December 16, 2015 Mark Sharp Partner M. Aaron Little Managing Director 1

2 TO RECEIVE CPE CREDIT Participate in entire webinar Answer polls when they are provided If you are viewing this webinar in a group Complete group attendance form with Title & date of live webinar Your company name Your printed name, signature & address All group attendance sheets must be submitted to training@bkd.com within 24 hours of live webinar Answer polls when they are provided If all eligibility requirements are met, each participant will be ed their CPE certificates within 15 business days of live webinar Payment & Billing Updates 2

3 PAYMENT & BILLING UPDATES Key resources Final Medicare hospice payment rule Federal Register dated August 6, 2015 Wage index adjustments issued in separate document Other billing & payment details issued in Change Requests (CRs) CR9201 dated August 14, 2015 & MLN Matters Article MM9201 Medicaid memorandum dated September 1, 2015 CR9301 dated September 15, 2015, & MLN Matters Article MM9301 CR9369 dated October 16, 2015, & MLN Matters Article MM9369 ESTIMATED IMPACT OF UPDATES 1.1% Increase in 2016 Hospice Payments 6 3

4 PAYMENT & BILLING UPDATES Key dates October 1, 2015 New payment rates New CBSA codes New claim diagnosis coding requirements January 1, 2016 New RHC rates New SIA payment Payment Rates Effective October 1,

5 PAYMENT RATES Level of Care Labor Portion Non-labor Portion Final Rate* Routine home care (RHC) $ $ $ Continuous home care (CHC) (per hour) $ $ $ Inpatient respite care $ $ $ General inpatient care (GIP) $ $ $ * All rates effective for service dates October 1, 2015, through December 31, Reflect an increase of over prior year. Rates subject to additional 2% reduction if required quality data not submitted. All rates prior to considering wage-index adjustment & 2% sequestration reduction. New RHC Rates Effective January 1,

6 RHC payment rate RHC high rate RHC low rate Paid for days one through 60 of hospice episode of care Paid for days 61 & after of hospice episode of care Episode of care = Hospice election period(s) separated by no more than 60-day gap per Medicare Common Working File data PAYMENT RATES Level of Care Labor Portion Non-labor Portion Final Rate* RHC high rate $ $ $ RHC low rate $ $ $ * All rates effective for services dates January 1, Rates subject to 2% reduction if required quality data not submitted. All rates prior to considering wage-index adjustment & 2% sequestration reduction. 6

7 New SIA Payment Effective January 1, 2016 Applies only to last seven days of life when patient is discharged deceased Applies only to RHC level of care Applies only to visits made by registered nurses (RNs) or medical social workers (MSWs) Excludes licensed practical nurse (LPN) visits & medical social worker phone calls 7

8 Payment amount equivalent to CHC rate Paid in 15-minute increments Combined time by RNs & MSWs Paid up to four total hours per day Estimating Impact 8

9 SAMPLE IMPACT ASSESSMENT 17 SAMPLE IMPACT ASSESSMENT 18 9

10 SAMPLE IMPACT ASSESSMENT 19 SAMPLE IMPACT ASSESSMENT 20 10

11 SAMPLE IMPACT ASSESSMENT 21 SAMPLE IMPACT ASSESSMENT 22 11

12 CBSA Codes Effective October 1, 2015 CBSA CODES Transition billing codes used only for service dates October 1, 2015, through September 30, 2016 Codes begin with 50xxx Use of CBSA code or transition billing code depends on county in which patient resides 72 CBSA codes replaced by transition billing codes 12

13 Code Name Code Name Code Name Aguadilla-Isabela, PR Deltona-Daytona Beach-Ormond Beach, FL Memphis, TN-MS-AR Amarillo, TX Dutchess County-Putnam County, NY Midland, TX Atlanta-Sandy Springs-Roswell, GA Elizabethtown-Fort Knox, KY Minneapolis-St. Paul-Bloomington, MN-WI Augusta-Richmond County, GA-SC El Paso, TX Myrtle Beach-Conway-North Myrtle Beach, SC-NC Beaumont-Port Arthur, TX Fort Worth-Arlington, TX Nashville-Davidson-Murfreesboro-Franklin, TN Billings, MT Grand Rapids-Wyoming, MI Newark, NJ-PA Blacksburg-Christiansburg-Radford, VA Greenville-Anderson-Mauldin, SC New Orleans-Metairie, LA Bloomington, IL Gulfport-Biloxi-Pascagoula, MS New York-Jersey City-White Plains, NY-NJ Bowling Green, KY Huntington-Ashland, WV-KY-OH Ogden-Clearfield, UT Cambridge-Newton-Framingham, MA Idaho Falls, ID Panama City, FL Charlotte-Concord-Gastonia, NC-SC Indianapolis-Carmel-Anderson, IN Ponce, PR Charlottesville, VA Lafayette, LA Rapid City, SD Cincinnati, OH-KY-IN Louisville/Jefferson County, KY-IN Rochester, MN Columbus, OH Lubbock, TX Rochester, NY Crestview-Fort Walton Beach-Destin, FL Madison, WI Salisbury, MD-DE Note: Represents CBSA codes invalid for use on Medicare hospice claims with service dates October 1, 2015, through September 30, Codes are replaced by transition 50xxx billing codes. Code Name Code Name Code Name San Juan-Carolina-Caguas, PR Rural Kansas Shreveport-Bossier City, LA Rural Kentucky Sioux City, IA-NE-SD Rural Massachusetts Spartanburg, SC Rural Michigan Spokane-Spokane Valley, WA Rural Mississippi Tuscaloosa, AL Rural Missouri Virginia Beach-Norfolk-Newport News, VA-NC Rural North Carolina Waco, TX Rural Ohio Washington-Arlington-Alexandria, DC-VA-MD-WV Rural Texas Wichita, KS Rural Utah Winston-Salem, NC Rural Virginia Worcester, MA-CT Rural West Virginia Rural Alabama Rural Idaho Rural Indiana Note: Represents CBSA codes invalid for use on Medicare hospice claims with service dates October 1, 2015, through September 30, Codes are replaced by transition 50xxx billing codes. 13

14 CBSA CODES Payment rate tables available on bkd.com Tables for each state contain rates for each level of care for each county in state Rates available for October 1, 2015, & January 1, 2016 Claim Diagnosis Coding Effective October 1,

15 CLAIM DIAGNOSIS CODING Claims must report all diagnoses Identified in initial & comprehensive assessments Whether related or unrelated to terminal prognosis All diagnoses that affect patient care Includes any mental health disorders & conditions that would affect plan of care According to coding guidelines New RHC Rates Effective January 1,

16 New hospice admissions on or after 01/01/16 Prior hospice services? Yes Less than 60 days since? Yes Days 61 & after paid RHC low rate No No Days 1 through 60 paid RHC high rate Example 01/15/16 admitted 03/28/16 deceased RHC level of care entire length of stay No prior hospice services 01/15/16 (day 1) through 03/14/16 (day 60) paid RHC high rate 03/15/16 (day 61) through 03/28/16 paid RHC low rate 16

17 Example 01/15/16 admitted 02/20/16 revoked No prior hospice services 03/02/16 readmitted 04/27/16 deceased RHC level of care entire length of stay 01/15/16 (day 1) through 02/20/16 (day 37) paid RHC high rate 03/02/16 (day 38) through 03/24/16 (day 60) paid RHC high rate 03/25/16 (day 61) through 04/27/16 paid RHC low rate Example 01/15/16 admitted 02/20/16 revoked No prior hospice services 03/02/16 readmitted 04/27/16 deceased RHC level of care entire length of stay except for GIP period 03/05/16 through 03/09/16 01/15/16 (day 1) through 02/20/16 (day 37) paid RHC high rate 03/02/16 (day 38) through 03/04/16 (day 40) paid RHC high rate 03/05/16 (day 41) through 03/09/16 (day 45) paid GIP 03/10/16 (day 46) through 03/24/16 (day 60) paid RHC high rate 03/25/16 (day 61) through 04/27/16 paid RHC low rate 17

18 Example 01/15/16 admitted 04/27/16 deceased RHC level of care entire length of stay Prior hospice services 10/02/15 (day 1) through 11/01/15 (day 31 11/16/15 (day 32) through 12/02/15 (day 48) 01/15/16 (day 49) through 01/25/16 (day 60) paid RHC high rate 01/26/16 (day 61) through 04/27/16 paid RHC low rate New SIA Payment Effective January 1,

19 Applies only to visits made by RNs or MSWs Requires two new HCPCS G codes G0299 RN services G0154 Retired as of 01/01/16 G0300 LPN services Applies to both hospice & home health E x a m p l e 1 Patient deceased 02/07/16, RHC high rate each day (Tulsa, OK) Date 02/01/ Revenue Code HCPCS Visit G0299 G0155 RN visit MSW visit 15-Minute Increments 6 units 3 units SIA Payment $ /02/ G0300 LPN visit 8 units None 02/03/15 xxx xxxxx No visits None None 02/04/ G0299 LPN visit 4 units None 02/05/ G0299 G0155 RN visit MSW visit 12 units 4 units $ /06/ G0299 RN visit 13 units $ /07/ G0299 RN visit 10 units $ Total $ $1, RHC high rate for seven days, after 2% reduction for sequestration SIA payment for 48 units, after 2% reduction for sequestration $1, Total claim payment 19

20 E x a m p l e 2 Patient deceased 03/27/16, RHC low rate each day (Tulsa, OK) Date Revenue Code HCPCS Visit 15-Minute Increments SIA Payment 03/21/ G0299 RN visit 2 units $ /22/ G0155 MSW phone call 3 units None 03/23/15 xxx xxxxx No visits None None 03/24/ /25/ G0300 G0155 G0300 G0155 LPN visit MSW visit LPN visit MSW visit 4 units 2 units 10 units 2 units $ $ /26/ G0299 RN visit 20 units $ /27/ G0299 RN visit 10 units $ Total $ $3, RHC low rate for 27 days, after 2% reduction for sequestration SIA payment for 32 units, after 2% reduction for sequestration $3, Total claim payment E x a m p l e 3 Patient deceased 03/27/16, RHC low rate each day except last three days of GIP (Tulsa, OK) Date Revenue Code HCPCS Visit 15-Minute Increments SIA Payment 03/21/ G0300 LPN visit 2 units None 03/22/ G0155 MSW phone call 3 units None 03/23/15 xxx Xxxxx No visits None None 03/24/ G0300 G0155 LPN visit MSW visit 4 units 2 units $ /25/ G0299 RN visits (GIP) 10 units None 03/26/ G0299 RN visits (GIP) 20 units None 03/27/ G0299 RN visits (GIP) 10 units None Total $ $4, Total RHC low rate for 24 days and three days of GIP, after 2% reduction for sequestration SIA payment for two units, after 2% reduction for sequestration $4, Total claim payment 20

21 Summary RHC high rate paid days 1 to 60 RHC low rate paid day 61 & after SIA available last seven days 21

22 SUMMARY Prepare software system for new October 1, 2015, & January 1, 2016, payment rates Assess financial impact to your agency by new RHC rates & SIA payment Confirm correct billing codes for all counties in your agency s service area QUESTIONS? 22

23 CONTINUING PROFESSIONAL EDUCATION (CPE) CREDITS BKD, LLP is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: The information in BKD webinars is presented by BKD professionals, but applying specific information to your situation requires careful consideration of facts & circumstances. Consult your BKD advisor before acting on any matters covered in these webinars. CPE CREDIT CPE credit may be awarded upon verification of participant attendance For questions, concerns or comments regarding CPE credit, please the BKD Learning & Development Department at training@bkd.com 23

24 THANK YOU! FOR MORE INFORMATION Mark Sharp Partner M. Aaron Little Managing Director 24