Eli's Hospice Insider
Is Your Claim Coding Messing Up Beneficiaries' Enrollment Periods?
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CMS issues revised instructions for hospice discharge billing. You need to use the correct codes on your hospice claims for discharged patients, or their benefit information won't be accurate. Hospices can discharge benes for three reasons, the Centers for Medicare & Medicaid Services notes in Transmittal No. 2258 (CR 7473) issued July 29. The bene moves or transfers to another hospice; is no longer terminally ill; or is discharged for cause. When the bene transfers, hospices should use discharge code 50 or 51 without occurrence code 42. "This discharge claim does not terminate the beneficiary's current hospice benefit period," CMS explains in a related MLN Matters article. When the bene moves without a transfer, hospices should use whatever National Uniform Billing Committee (NUBC)-approved discharge status code best describes the beneficiary's situation, CMS directs. The hospice won't report occurrence code 42 on their claim. "This discharge claim will terminate the beneficiary's current hospice benefit period as of the 'Through' date on the claim," CMS explains. When the bene is no longer terminally ill or revokes hospice, hospices should use the appropriate NUBC discharge code and occurrence code 42. "This discharge claim will terminate the beneficiary's current hospice benefit period as of the occurrence code 42 date," CMS specifies. When the patient is discharged for cause, hospices should use the appropriate NUBC discharge code and an "H2" condition code, CMS instructs. Unless the patient transfers, the current benefit period will terminate on the "through" date of the claim. Under all but the transfer options, "the beneficiary may re-elect the hospice benefit at any time as long as they remain eligible for the benefit," CMS assures. The CR is at www.cms.gov/Transmittals/downloads/R2258CP.pdf and the MLN Matters article is at www.cms.gov/MLNMattersArticles/Downloads/MM7473.pdf. The CR also contains information on billing hospice for Medicare Advantage plans.
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