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CMS Wants More Data on Hospice Claims

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  • In CMS
  • February 15, 2010
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Recently implemented changes to Medicare billing instructions requiring hospices to report certain additional data on claims and another change requiring more detail is forthcoming.

Effective for claims with dates of service on or after Jan. 1, hospices are now required to report visits, certain phone calls, and visit or call intensity for nearly all hospice days billed, according to line item date of service, provided under routine home care (RHC), continuous home care (CHC), and respite care.
Note: Billing of physician visits to hospice patients is not affected by this change.
New reporting requirements include those provided by physical therapists, occupational therapist, and speech-language pathologists. Telephone calls made by social workers to the patient or the patient’s family must also be reported.
Each visit performed by hospice-employed or contracted nurses, aides, social workers, and therapists, and social worker phone calls to the patient/patient’s family must be billed on a separate revenue code line, with a corresponding HCPCS Level II code, and the intensity of each visit reported in 15-minute increments.
Revenue codes with associated HCPCS Level II codes are as follows:

  • Revenue Code 042x with G0151 Services of a physical therapist in home health or hospice settings, each 15 minutes
  • Revenue Code 043x with G0152 Services of an occupational therapist in home health or hospice settings, each 15 minutes
  • Revenue Code 044x with G0153 Services of a speech and language pathologist in home health or hospice settings, each 15 minutes
  • Revenue Code 055x with G0154 Services of skilled nurse in home health, or nurse in hospice settings, each 15 minutes
  • Revenue Code 056x with G0155 Services of clinical social worker in home health or hospice settings, each 15 minutes
  • Revenue Code 057x with G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes

For example, hospices should report each telephone call that social workers made to the patient or the patient’s family using revenue code 0569 and HCPCS Level II code G0155 for the length of the call, with each call being a separate line item. Report only those telephone calls that are necessary for 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 a placement). 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.
When recording any visit or social worker phone call time, you should sum the time for each visit or call, rounding to the nearest 15-minute increment and report in the unit field on the line level the units as a multiplier of the visit time defined in the HCPCS Level II description. Do not include travel time or documentation time in the time recorded for any visit or call. Additionally, you may not include interdisciplinary group time in time and visit reporting.
Note: Visits provided by non-hospice staff in a contracted respite facility are not required to be reported. In addition, visits provided under General Inpatient (GIP) are not impacted by this billing change.

On the Horizon

Effective April 29, hospices also will be required to report on claims separate line items for each level of care. This includes revenue codes 0651, 0655, and 0656.
For example, if a patient begins the month receiving routine home care followed by a period of GIP care, and then later returns to routine home care all in the same month, in addition to the one line reporting the GIP care days, there should be two separate line items for routine home care. Each routine home care line reports a line item service date to indicate the first date that level of care began for that consecutive period.
Sources: The Centers for Medicare & Medicaid Services (CMS) Transmittals CR 5567, CR 6440 and CR 6791, and MLN Matters article MM6440.

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