New Code to Report Date of Death on Medicare Claims

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

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Hospice Quality Reporting Program Update

Hospices will be mandated-for the first time-to collect data on specific quality measures during the final calendar quarter of 2012 as part of the Hospice Quality Reporting Program. Failure by a hospice to submit the required data will result in a 2 percent reduction to that hospice’s payments during fiscal year 2014

In the June 4, 2012 Federal Register there is a notice regarding the data submission form to be used for reporting the required quality data. The Hospice Quality Reporting Program submission forms is now available, once you download the form click on “Hospice Mandatory Data Submission Form”.

For additional information about the Hospice Quality Reporting Program Click Here

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Guest Blog Post: National Health Care Decisions Day is Apr. 16

The Home Care Alliance thanks John Albert, President and CEO of Home Health VNA and Merrimack Valley Hospice for his guest blog post.

On Monday, April 16, National Health Care Decisions Day, I urge you to take some time to have a thoughtful conversation with family members and loved ones about your end-of-life healthcare decisions, and to complete an advanced directive. By having these conversations and documenting your wishes in an advanced directive, your health care decisions will be respected by health care professionals and your personal wishes will be honored.

Discussing end-of-life decisions before they are needed can help you and your family prepare for any emergency.  By completing an advanced directive, you can provide useful guidance to loved ones, and health care providers so that your wishes will be honored in the event you cannot speak for yourself.  You can fill out an advanced directive without hiring a lawyer.  It is easy to do and it is free.

Massachusetts recognizes two main forms of advanced directives:

  • A “Massachusetts Health Care Proxy” is a simple, legal document that allows you to appoint someone you know and trust to make decisions on your behalf if you cannot speak for yourself
  • Five Wishes is a “living will” a legal document that instructs your family and your health care providers about your personal, emotional and spiritual needs and your medical wishes at the end of life

It is important to ask yourself: Who will speak for me and respect my health care choices if I am unable to do so?  You can find more information on advanced directives at

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State Bill Filed to Expand Hospice Coverage

According to a report by State House News Service, a bill was recently filed by a group of legislators that would expand hospice coverage to about 120,000 more residents on MassHealth.

Senate Bill 1999, An Act extending hospice care to the MassHealth basic and MassHealth essential programs was filed by Senator Patricia Jehlen and seeks what its title states. Hospice coverage, according to State House News, is available to about 1 million MassHealth recipients, but not to roughly 120,000 who are on more restrictive plans known as MassHealth Basic and MassHealth Essential.

The inspiration for this bill comes from a report assembled by the Massachusetts Commission on End-Of-Life Care, which was established by the legislature in 2009 to study issues surrounding end-of-life care and how such care is provided in the state.

The Home Care Alliance applauds the initiative to expand hospice coverage so that people can fulfill their preference to receive end-of-life care in their homes. While approximately 67 percent of Massachusetts residents say they would prefer to die at home, only 24 percent actually do, according to statistics compiled by the commission, the Massachusetts chapter of AARP, and the state Department of Public Health.

The legislation has been referred to the Joint Committee on Health Care Financing and the Alliance will continue to provide updates on this proposal as it becomes available.

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OIG Examines Hospice Services for Nursing Facility Residents

A new report from the Office of Inspector General has found that Medicare spending on hospice care for nursing facility residents has grown nearly 70 percent since 2005.  Many hospices had a high percentage of their beneficiaries residing in nursing facilities, and most of these hospices were for-profit. Compared to hospices nationwide, these high-percentage hospices:

  • received more Medicare payments
  • had a longer average length of stay
  • served Medic are patients whose diagnoses required less complex care
  • served more patients who already lived in nursing facilities before they elected hospice care.

A previous OIG study published in September, 2009, concluded that Eighty-two percent of hospice claims for beneficiaries residing in nursing facilities did not meet Medicare coverage requirements.

The OIG report notes that Medicare currently pays hospices the same rate for care provided in nursing facilities as it does for care provided in the home, but nursing facilities are staffed with professional caregivers and are often paid by third party payers, such as Medicaid. These facilities are required to provide personal care services, which are similar to hospice aide services that are paid for under the hospice benefit.

The OIG concluded that some hospices may be seeking beneficiaries with particular characteristics, including those with conditions associated with longer but less complex care. Such beneficiaries are often found in nursing facilities. By serving these beneficiaries for longer periods, the hospices receive more Medicare payments, which can contribute to larger profits.

The OIG report recommends that CMS (1) monitor hospices that depend heavily on nursing facility residents and (2) modify the payment system for hospice care in nursing facilities. CMS concurred with both of our recommendations. It also agreed that the current payment structure may provide incentives for hospices to seek out beneficiaries in nursing facilities, who often receive longer but less complex care

The OIG website has a special page devoted to Medicare hospice issues.  The page includes links to the new report, a podcast interview with Jodi Nudelman, the Region II Inspector General for Evaluation and Inspections, and several other OIG studies of hospice issues.  This is the first in a series of three studies by the OIG of hospice services to nursing facility residents.  Additional studies will examine the marketing practices of hospices that focus on nursing home residents and the business relationships of such hospices with nursing facilities.

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Payment Rate Change Announced for Hospice

The state’s Division of Health Care Finance and Policy (DHCFP) announced an adjustment in the rate of payment for hospice services “in accordance with CMS requirements.”

The full announcement is available here.

The change is estimated by DHCFP to increase the MassHealth budget by $184,274 or 2.68%, which translates to a slight increase and not a cut as is sometimes meant when the state uses the word “adjustment.” According to the announcment, each rate is composed of a non-wage component and a wage component, in which the latter is adjusted by a county-specific, Massachusetts wage index, in accordance with CMS guidelines.

Depending on the service, the rates in these county-groupings change within the following ranges:

  • 3.5-3.7% for Norfolk, Suffolk, and Plymouth,
  • 3.0-3.2% for Middlesex,
  • 2.6-2.7% for Essex,
  • 2.4-2.5% for Bristol, 3.2-3.4% for Berkshire and Pittsfield,
  • 1.7-1.9% for Hampden, Hampshire, and Franklin,
  • 3.4-3.6% for Worcester,
  • 1.6-1.9% for Barnstable
  • 1.9-2.2% for Nantucket and Dukes.

Although the revisions were adopted by emergency regulation on May 27, they are still technically “proposed” and are subject to further change. DHCFP announced that there will be a hearing on July 7 in Boston for anyone interested in offering comments on the matter. See the full announcement for details.

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