PREPARING FOR THE 2016 HOSPICE PAYMENT CHANGES December 16, 2015 Mark Sharp Partner msharp@bkd.com M. Aaron Little Managing Director mlittle@bkd.com 1
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 & email 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 emailed their CPE certificates within 15 business days of live webinar Payment & Billing Updates 2
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
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, 2015 4
PAYMENT RATES Level of Care Labor Portion Non-labor Portion Final Rate* Routine home care (RHC) $ 111.23 $ 50.66 $ 161.89 Continuous home care (CHC) (per hour) $ 27.05 $ 12.32 $ 39.37 Inpatient respite care $ 90.64 $ 76.81 $ 167.45 General inpatient care (GIP) $ 460.94 $ 259.17 $ 720.11 * All rates effective for service dates October 1, 2015, through December 31, 2015. Reflect an increase of 1.016 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, 2016 5
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 $ 128.38 $ 58.46 $ 186.84 RHC low rate $ 100.89 $ 45.94 $ 146.83 * All rates effective for services dates January 1, 2016. Rates subject to 2% reduction if required quality data not submitted. All rates prior to considering wage-index adjustment & 2% sequestration reduction. 6
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
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
SAMPLE IMPACT ASSESSMENT 17 SAMPLE IMPACT ASSESSMENT 18 9
SAMPLE IMPACT ASSESSMENT 19 SAMPLE IMPACT ASSESSMENT 20 10
SAMPLE IMPACT ASSESSMENT 21 SAMPLE IMPACT ASSESSMENT 22 11
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
Code Name Code Name Code Name 10380 Aguadilla-Isabela, PR 19660 Deltona-Daytona Beach-Ormond Beach, FL 32820 Memphis, TN-MS-AR 11100 Amarillo, TX 20524 Dutchess County-Putnam County, NY 33260 Midland, TX 12060 Atlanta-Sandy Springs-Roswell, GA 21060 Elizabethtown-Fort Knox, KY 33460 Minneapolis-St. Paul-Bloomington, MN-WI 12260 Augusta-Richmond County, GA-SC 21340 El Paso, TX 34820 Myrtle Beach-Conway-North Myrtle Beach, SC-NC 13140 Beaumont-Port Arthur, TX 23104 Fort Worth-Arlington, TX 34980 Nashville-Davidson-Murfreesboro-Franklin, TN 13740 Billings, MT 24340 Grand Rapids-Wyoming, MI 35084 Newark, NJ-PA 13980 Blacksburg-Christiansburg-Radford, VA 24860 Greenville-Anderson-Mauldin, SC 35380 New Orleans-Metairie, LA 14010 Bloomington, IL 25060 Gulfport-Biloxi-Pascagoula, MS 35614 New York-Jersey City-White Plains, NY-NJ 14540 Bowling Green, KY 26580 Huntington-Ashland, WV-KY-OH 36260 Ogden-Clearfield, UT 15764 Cambridge-Newton-Framingham, MA 26820 Idaho Falls, ID 37460 Panama City, FL 16740 Charlotte-Concord-Gastonia, NC-SC 26900 Indianapolis-Carmel-Anderson, IN 38660 Ponce, PR 16820 Charlottesville, VA 29180 Lafayette, LA 39660 Rapid City, SD 17140 Cincinnati, OH-KY-IN 31140 Louisville/Jefferson County, KY-IN 40340 Rochester, MN 18140 Columbus, OH 31180 Lubbock, TX 40380 Rochester, NY 18880 Crestview-Fort Walton Beach-Destin, FL 31540 Madison, WI 41540 Salisbury, MD-DE Note: Represents CBSA codes invalid for use on Medicare hospice claims with service dates October 1, 2015, through September 30, 2016. Codes are replaced by transition 50xxx billing codes. Code Name Code Name Code Name 41980 San Juan-Carolina-Caguas, PR 99917 Rural Kansas 43340 Shreveport-Bossier City, LA 99918 Rural Kentucky 43580 Sioux City, IA-NE-SD 99922 Rural Massachusetts 43900 Spartanburg, SC 99923 Rural Michigan 44060 Spokane-Spokane Valley, WA 99925 Rural Mississippi 46220 Tuscaloosa, AL 99926 Rural Missouri 47260 Virginia Beach-Norfolk-Newport News, VA-NC 99934 Rural North Carolina 47380 Waco, TX 99936 Rural Ohio 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 99945 Rural Texas 48620 Wichita, KS 99946 Rural Utah 49180 Winston-Salem, NC 99949 Rural Virginia 49340 Worcester, MA-CT 99951 Rural West Virginia 99901 Rural Alabama 99913 Rural Idaho 99915 Rural Indiana Note: Represents CBSA codes invalid for use on Medicare hospice claims with service dates October 1, 2015, through September 30, 2016. Codes are replaced by transition 50xxx billing codes. 13
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, 2015 14
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, 2016 15
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
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
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, 2016 18
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 02/01/16 0551 0561 Revenue Code HCPCS Visit G0299 G0155 RN visit MSW visit 15-Minute Increments 6 units 3 units SIA Payment $ 74.88 02/02/16 0551 G0300 LPN visit 8 units None 02/03/15 xxx xxxxx No visits None None 02/04/16 0551 G0299 LPN visit 4 units None 02/05/16 0551 0561 G0299 G0155 RN visit MSW visit 12 units 4 units $ 133.12 02/06/16 0551 G0299 RN visit 13 units $ 108.16 02/07/16 0551 G0299 RN visit 10 units $ 83.20 Total $ 399.36 $1,105.58 RHC high rate for seven days, after 2% reduction for sequestration 399.36 SIA payment for 48 units, after 2% reduction for sequestration $1,504.94 Total claim payment 19
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 03/21/16 0551 G0299 RN visit 2 units $ 16.64 03/22/16 0569 G0155 MSW phone call 3 units None 03/23/15 xxx xxxxx No visits None None 03/24/16 0551 0561 03/25/16 0551 0561 G0300 G0155 G0300 G0155 LPN visit MSW visit LPN visit MSW visit 4 units 2 units 10 units 2 units $ 16.64 $ 16.64 03/26/16 0551 G0299 RN visit 20 units $ 133.12 03/27/16 0551 G0299 RN visit 10 units $ 83.20 Total $ 266.24 $3,351.24 RHC low rate for 27 days, after 2% reduction for sequestration 266.24 SIA payment for 32 units, after 2% reduction for sequestration $3,617.48 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 03/21/16 0551 G0300 LPN visit 2 units None 03/22/16 0569 G0155 MSW phone call 3 units None 03/23/15 xxx Xxxxx No visits None None 03/24/16 0551 0561 G0300 G0155 LPN visit MSW visit 4 units 2 units $ 16.64 03/25/16 0551 G0299 RN visits (GIP) 10 units None 03/26/16 0551 G0299 RN visits (GIP) 20 units None 03/27/16 0551 G0299 RN visits (GIP) 10 units None Total $ 16.64 $4,824.96 Total RHC low rate for 24 days and three days of GIP, after 2% reduction for sequestration 16.64 SIA payment for two units, after 2% reduction for sequestration $4,841.60 Total claim payment 20
Summary RHC high rate paid days 1 to 60 RHC low rate paid day 61 & after SIA available last seven days 21
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
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THANK YOU! FOR MORE INFORMATION Mark Sharp Partner msharp@bkd.com M. Aaron Little Managing Director mlittle@bkd.com 24