Be prepared to defend your inpatient claims with care intensity documentation.
If you've been billing for a hospice general inpatient day when your patients' caregiver support fails, you'll have to change your ways--and receive a lot less reimbursement.
Hospices may bill Medicare for a general inpatient day only when beneficiaries require "an intensity of care directed towards pain control and symptom management that cannot be managed in any other setting," the Centers for Medicare & Medicaid Services says in a proposed rule recently posted to its Web site.
That means hospices cannot bill for higher-paying inpatient care due to "caregiver breakdown," even when the patient comes to stay in the inpatient facility. "'Caregiver breakdown' should not be billed as 'general inpatient care' regardless of where services are provided, unless the intensity-of-care requirement is met," CMS stresses in the hospice wage index proposed rule.
Scrutiny ahead: Hospices should bill at the respite care or routine home care rates instead, CMS directs. "We intend to monitor the usage of the general inpatient care," the rule warns.
The rule also sets hospice wage index levels for 2008 and clarifies some lingering wage index questions. And the regulation spells out that although CMS pulled back on its requirement that the attending physician and hospice medical director consult directly about patient eligibility, that doesn't mean the admission nurse can determine eligibility based on the patient's record.
The proposed rule is online at
www.cms.hhs.gov/MLNProducts/downloads/cms-1539-p.pdf Hospices have until June 2 to comment on the proposal. • The 60-day window for home medical equipment bidding should start soon. That's the latest word from CMS on the opening of the bidding process for Medicare's new competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).
Best bet: Stay tuned to the Competitive Bidding Implementation Contractor Web site (
www.dmecompetitivebid.com) for updates and the announcement about the start of bidding, a CMS spokesperson tells Eli.
Initially, CMS reported that bidding under the DMEPOS competitive bidding program would open in late April. But on May 8, CMS posted an "important message" on its DMEPOS competitive bidding Web site saying that it has extended the target date for opening the bidding window to early May.
The extended target date will provide additional time for DMEPOS suppliers to review educational materials and prepare for bidding, and additional time for CMS to test its on-line bidding system, say officials. • Even though CMS is putting mail-order diabetic supplies up for nationwide bid under durable medical equipment competitive bidding, it won't affect all providers and beneficiaries nationwide--at first.
At the April 23 National Association for Home Care & Hospice policy conference in Washington, DC, CMS' Carol Blackford noted that mail-order supplies would be going up for nationwide bid (see Eli's [...]
