Eli's Hospice Insider

Published on Tue Jan 23, 2018 PDF

Line item dates of service may be the culprit for problem adjustments.

Thought you were done with payment reform billing corrections because you submitted adjustments for all the errors? You may have to think again.

The problem: Some hospice claims for Routine Home Care "should have received a corrected payment, but did not due to incorrect line item date(s) of service billed for RHC revenue code 0651," HHH Medicare Administrative Contractor CGS says on its website. "For example, a claim is submitted with an admission date of April 26, 2017, with the dates of service 060117 - 063017 showing 30 units, representing 30 days. However, the claim reported the first date for the RHC level of care as 062517 instead of 060117. As a result, the Fiscal Intermediary Standard System (FISS) determined the dates from 0625 to 0630 occurred during the first 60 days of the episode and were paid the incorrect RHC amount."

The solution: You'll need to correct the line item dates of service if they are in error. "Hospice claims are required to report separate line items for the level of care each time the level of care changes. This includes revenue codes 0651, 0655 and 0656," CGS explains. "If you have a claim that you feel paid the incorrect RHC 'High' or 'Low' rate, please review to ensure the correct line item dates of service was reported, and adjust accordingly," the MAC urges.

See more details about the fix at www.cgsmedicare.com/hhh/pubs/news/2017/1217/cope5643.html.