Eli's Hospice Insider

Published on Wed Aug 17, 2016 PDF

Some payment reform glitches are finally resolved, at least.

If trying to figure out why your hospice payments aren’t reconciling with your billing is driving you crazy, you aren’t alone.

In its July 13 Open Door Forum for home care and hospice providers, the Centers for Medicare & Medicaid Services ran down a list of payment reform-related billing glitches. Some have been fixed or are scheduled for correction soon, while others have had failed corrections and are scheduled for resolution next year.

Fixed: The system does appear to be corrected for a problem in which prior hospice days weren’t being counted for Routine Home Care calculation purposes because a revocation was filed before the final claim, a CMS staffer explained. Hospices had been overpaid due to the error.

Fixed soon: Another problem occurs when the claims system uses days from a prior hospice stay to count toward RHC when they should not count, because it has been more than 60 days since the stay ended. The fix for this problem that underpays hospices was scheduled for July 25, the CMS official told forum attendees.

Long wait: Two other fixes aren’t scheduled until January, however. In one problem, the claims system isn’t applying the correct day count for RHC rate setting. In another, Service Intensity Add-on payments are not being correctly applied, the CMS source explained.

“While changes to correct both of these problems have been completed by the MACs, the changes did not fully address the problems, so additional changes must be made,” explains the National Association for Home Care & Hospice in its member newsletter.

CMS has issued a Change Request transmittal detailing the two January corrections at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3577CP.pdf. These changes to the system have to go through the “complete system development life cycle, which does tend to take longer” — thus the January implementation, the staffer acknowledged.