Once again, the actions of the few bad actors in home health and hospice are getting media attention rather than the vast majority of agencies that are devoted to providing high quality care to keep people comfortable and at home.
In an investigative report, the Washington Post highlights findings that the number of patients discharged alive from hospice rose by 50 percent between 2002 and 2012. The article also highlights numbers from the Medicare Payment Advisory Commission (MedPAC) stating that in 2011, nearly 60 percent of Medicare’s hospice expenditure of $13.8 billion went toward patients who stay on hospice care longer than six months. The article singles out for-profit hospices in particular, but still puts all hospices in a negative context.
We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones. Articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys. Under these circumstances, no one is well served.
What’s happening here? Hospices have lamented for years that dying patients wait too long to call, enrolling at the eleventh hour when they could have benefited months earlier. Now, we’re hearing more about patients doing as hospice believers (including me) have urged, calling earlier in the course of a terminal disease — and then, in a substantial minority of cases, getting bounced.
Health Insurance Prospective Payment System (HIPP)S codes on Medicare Advantage (MA) plan claims will be delayed until July 2014 according to information from NAHC. Bellow is an excerpt from a letter CMS sent to the health plan.
”MAOs and other entities were instructed that effective December 1, 2013 dates of service (DOS), the disposition for the HIPPS codes edits would be changed from ‘Informational’ to ‘Reject’ for any Skilled Nursing Facility (SNF) and Home Health (HH) encounters submitted without the appropriate HIPPS codes. The purpose of this notification is to let you know that the December 1, 2013 DOS ‘Reject’ edit will be delayed to July 1, 2014 DOS. The ‘Informational’ edit for HIPPS codes would remain in place until that time.”
Are your ordering/referring physicians enrolled in PECOS?
On June 20th CMS released a revised MLN Matters article with updated information regarding PECOS and Phase 2 of the Ordering/Referring Physician Requirements.
During Phase 2, Medicare will deny Part A HHA claims that fail the ordering/referring provider edits. CMS has not announced a date when the edits for Phase 2 will become active. CMS will give the provider community at least 60 days notice prior to turning on these edits. Physicians and others who are eligible to order and refer items or services need to establish their Medicare enrollment record (PECOS).
It is possible that it could take 45-60 days, sometimes longer, for Medicare enrollment contractors to process enrollment applications. All enrollment applications, including those submitted over the web, require verification of the information reported. Sometimes, Medicare enrollment contractors may request additional information in order to process the enrollment application.
Waiting too late to begin this process could mean that physicians’ enrollment applications will not be able to be processed prior to the implementation date of Phase 2 of the ordering/referring provider edits. In Phase 2, if the Ordering/Referring Provider does not pass the edits, the claim will be denied.This means that the billing provider will not be paid for the items or services that were furnished based on the order or referral. For more information Click Here
October is months away but be prepared…Effective Oct.1, 2012 Medicare-certified agencies will use occurrence code 55 to indicate a date of death on claims.
The new occurrence code will be used in conjunction with all discharge status codes indicating the patient has expired – 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown)
Please note that hospices are not to use discharge status code 20 per Section 30.3 of Chapter 11 of the Medicare Claims Processing Manual. Additional information on the use of code 55 can be found in the MLN Matters and in the Change Request (CR) 7792