Home Health & Hospice Week
CMS To Ban Debility, Failure To Thrive As Primary Diagnoses On Hospice Claims
Most hospices still aren’t reporting secondary diagnoses, CMS fumes.
If you thought CMS was cracking down hard on hospice diagnosis coding already, just wait.
A whopping 72 percent of hospices continue to report only one diagnosis code on hospice claims, the Centers for Medicare & Medicaid Services says in its proposed rule for 2014 hospice payment rates. That’s down from 77 percent CMS found before it published its instructions on coding in last year’s hospice wage index notice. "All providers should code and report the principal diagnosis as well as all coexisting and additional diagnoses related to the terminal condition or related conditions to more fully describe the Medicare patients they are treating," CMS stresses in the rule scheduled for publication in the May 13 Federal Register.
"We are actively collecting and analyzing hospice data for evaluation of hospice payment reform methodologies," CMS continues. "To adequately account for any clinical complexities a given hospice patient might have as a result of related conditions, these related conditions must be included on the Medicare hospice claim," the agency insists.
CMS’s insistence on including more than one diagnosis code on a hospice claim is one of the rule’s most significant provisions, says Judi Lund Person with the National Hospice and Palliative Care Organization. The requirement "will get people’s attention," Person tells Eli.
Brace yourself: Accordingly, CMS plans to nix hospices’ use of "debility" (799.3) and "adult failure to thrive" (783.7) as primary diagnosis codes on claims. "When reported as a principal diagnosis, these would be considered questionable encounters for hospice care, and the claim would be returned to the provider for a more definitive principal diagnosis," CMS explains. "‘Debility’ and ‘adult failure to thrive’ could be listed on the hospice claim as other, additional, or coexisting diagnoses," CMS allows.
CMS also addresses coding for "Mental, Behavioral and Neuro-developmental Disorders" — namely dementia — and stresses the need for hospices to adhere to ICD-9 coding rules.
Note: For more information on home health ICD coding in Eli’s Home Health ICD-9 Alert and other products, go to https://www.aapc.com/codes/.
Home Health & Hospice Week
- Hospice:
Hospice Payment Rates To Tick Up 1% Next Year
CMS may cut how much you get paid for Routine Home Care. BNAF and Affordable [...] - Quality:
Get Ready To Collect These Hospice Data Items
Will ‘HIS’ data set become hospices’ OASIS? The Centers for Medicare & Medicaid Services wants [...] - Diagnosis Coding:
CMS To Ban Debility, Failure To Thrive As Primary Diagnoses On Hospice Claims
Most hospices still aren’t reporting secondary diagnoses, CMS fumes. If you thought CMS was cracking [...] - Strategy:
Use This Tool To Problem-Solve In Your Agency
Consider a ‘learning circle’ to crack tough issues. Whether you need your staff to brainstorm [...] - Tool:
Maximize 'Learning Circle' Potential With These Questions
Tip: Mix specific and open-ended questions. In addition to questions on specific clinical and policy [...] - Medical Re view:
CERT Reviewers Deny Claims Based On F2F
Would your face-to-face documentation pass medical review muster? Have you been letting docs slide on [...] - Industry Note:
Medicare Ramps Up Readmission Penalties
Plus: CMS adds two new DRGs to readmission penalty list. Hospitals soon will have even [...] - Industry Note:
E-Mail Causes Hospice HIPAA Violation
Make sure your staff are thoroughly trained — and reinforced — about HIPAA-compliant e-mail procedures. [...] - Industry Note:
Monitor Your RAPs
With HHH Medicare Administrative Contractor Palmetto GBA setting RAPs to pay nothing if you have [...] - Industry Note:
Trade Groups Merge
The National Association of Indepen-dent Medical Equipment Suppliers will merge with the American Association for [...] - Industry Note:
Counter Physician Signature Problems With Log
Are you having trouble with ordering physicians signing documentation differently at different times? Counter that [...] - Industry Note:
HHA Office Worker Pleads Guilty In Detroit
A home health office worker has pled guilty to Medicare fraud in the $24 million [...] - Industry Note:
Agency Closes In Face Of Medicaid Investigation
Deaconess Home Health in Milwaukee has closed in the face of a Medicaid investigation, leaving [...] - Industry Note:
Kindred Makes Texas Buy
Long-term care giant Kindred Health-care Inc. is aiming to increase its presence in the wider [...] - Industry Note:
San Diego Hospice Facility Goes To Highest Bidder
San Diego Hospice’s inpatient facility has gone to the highest bidder. After 50 bids in [...]
