Home Health & Hospice Week

Too many hospice providers are billing for place of service incorrectly -- and that could mess up more than reimbursement.

Hospices are treating patients in residential facilities and then incorrectly using HCPCS code Q5001 (Patient's home/residence) to get paid, according to regional home health intermediary Cahaba GBA's August newsletter.

Problem: HCPCS Q5001 is for when agencies provide hospice care in benes' homes -- and while "a residential care facility may serve as a beneficiary's residence, the beneficiary is actually residing in a facility," Cahaba points out.

The Centers for Medicare & Medicaid Services also wants agencies to carefully evaluate the available Q codes and then choose the one that accu rately names the place of service. CMS is collecting place of service data for all hospice claims. If you choose the wrong codes, its data won't be accurate.

For most patients not living in their homes, you'll use either Q5002 (Hospice care provided in assisted living facility), Q5003 (Hospice care provided in nursing long term care facility [LTC] or nonskilled nursing facility [NF]), or Q5004 (Hospice care provided in skilled nursing facility [SNF]), the newsletter says. But where a person resides isn't always her home.

Catch-all: Of course, not every place of service has a matching Q code. In those cases, choose Q5009 (Hospice care provided in place not otherwise specified [NOS]).