Eli's Hospice Insider

Published on Thu Jan 21, 2016 PDF

Industry’s profit margin figures hang in the balance.

If hospices fail to submit claims adjustments that don’t directly affect their reimbursement, they’ll risk looking more profitable than they really are.

The fix for the Medicare claims system glitch regarding hospice claims and anti-cancer/antiemetic drugs is in, so “hospice providers are encouraged to submit claim adjustments to add the unreported drug services in order to represent all their service costs in the claims data,” HHH Medicare Administrative Contractor CGS says in a message to providers.

Reminder: In April 2014, CMS required hospices to start reporting drugs on their claims. But a system edit restricted the allowable types of bill for the drugs, CMS noted in MLN Matters article 9255 last summer. “This edit does not include the hospice TOB. As a result, Medicare systems are returning hospice claims that report these drugs to the hospice in error.”

The problem is that hospices won’t actually receive any additional reimbursement for submitting the adjustments, so they may not want to take on the extra work. But with policy-shapers such as the Medicare Payment Advisory Commission examining hospices’ profit margins and making recommendations for no payment update (see story, p. 12), it may well be worth providers’ time, industry veterans urge.