Eli's Hospice Insider

Published on Wed Jul 19, 2017 PDF

Here’s how to handle Medicare Advantage plans on this tricky question.

Some of the Hospice Item Set questions are very straightforward, while others can leave you scratching your head. Medicare is offering some much-needed help with one of the more confusing HIS items on payors.

The Centers for Medicare & Medicaid Services isn’t kidding when it says on the HIS form to check all that apply for A1400 (Payor Information). “Identify all payors that the patient has, regardless of whether or not that payor is expected/likely to provide reimbursement,” CMS says in the HIS Manual. “A1400 should reflect all payors available for healthcare expenses. Healthcare expenses may include services, medications, supplies, and room and board,” CMS says in a new guidance sheet on the item.

Don’t be surprised if you mark Response J (Self-pay) for many of your patients, even if they’re not paying. “Self-Pay should be chosen even if the patient is not actively paying for anything, but could pay for something or has the funds if needed,” CMS says. “Selecting the self-pay response option obligates neither the hospice nor the patient to use those funds to pay for care, should a need to self-pay arise.”

Another tip: One quandary has been when they should mark “Response Option B. Medicare (managed care/Part C/Medicare Advantage),” since beneficiaries must disenroll from MA plans when they elect hospice. “If the patient was a Medicare Advantage patient prior to enrolling in hospice, select ‘B. Medicare (managed care/Part C/Medicare Advantage)’ even though Medicare Advantage may not reimburse the hospice directly for any services,” CMS instructs in the new guidance.

Don’t overlook: “If the patient was Part C/Medicare Advantage prior to enrolling in hospice, select the response options for BOTH part C and traditional fee-for-service, as applicable,” CMS adds.

Note: See the guidance sheet, which CMS first shared with the National Association for Home Care & Hospice before releasing it publicly, at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Downloads/CMS-Hospice-QRP-Master-Guidance-Item-A1400-June-2017-1.pdf. Access the HIS Manual, with its item-specific response instructions, at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Item-Set-HIS.html.