Eli's Hospice Insider

Published on Wed Sep 12, 2012 PDF

Hospices can turn to two new user guides and a training session for help.

The specifics of Medicare's new hospice quality data requirements are coming into focus, and you'd better make sure you're complying by Oct. 1.

"We encourage providers to prepare for both their data collection, which begins Oct. 1, and their data submission, which begins Jan. 1," said Robin Dowell with the Centers for Medicare & Medicaid Services in the Aug. 22 Open Door Forum for home care and hospice providers.

Providers should download and read both the User Guide for Hospice Quality Reporting Data Collection and the Technical User Guide for Hospice Quality Reporting Data Entry and Submission, Dowell instructed listeners. Links to the guides are online at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Spotlight.html.

While you can see the data entry instructions, the data entry website won't go live until Jan. 1, CMS notes on the site.

CMS will furnish training on hospice quality reporting the week of Nov. 12, Dowell added. The WebEx online training session will be available at www.qtso.com/hospice.html.

Other hospice issues addressed in the forum include:

• Inpatient visit reporting. How to report visits in the inpatient setting continues to befuddle hospices. One caller asked for specific guidance on counting visits when reassessing a patient for a symptom after an intervention for that symptom.

CMS has discussed counting inpatient visits in two transmittals -- CR 5567 and CR 6440 -- as well as the Medicare Claims Processing Manual, said CMS's Katie Lucas and Wendy Tucker.

Those documents give only vague guidance, protested Kim Waldman with Agrace HospiceCare based in Fitchburg, Wis. "That level of detail is not provided," she told CMS officials.

Resource: The transmittals are at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1494CP.pdf and www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1738cp.pdf. The claims processing manual is at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html -- hospice billing is covered in Chapter 11.

• Date of death. If you're having problems getting a patient's date of death corrected so you can bill, it may take a village to get it done. So indicated CMS officials in response to one hospice's question.

If the patient's incorrect date of death is due to a date submitted on another provider's claim, your Medicare Administrative Contractor should be able to change that rather easily, Tucker explained. But when the incorrect information is coming from the Social Security Administration itself, the task will be harder.

The hospice caller had been running into a brick wall in trying to get the SSA to change the date, despite providing a death certificate and other documentation, she said. As a result, the hospice was exceeding the timely filing deadline for the deceased beneficiary's claim.

Providers must get their MAC, their CMS Regional Office, and the SSA involved in such cases, Tucker suggested. Until the Common Working File is updated with an accurate date of death, the hospice claim won't go through.

• Cap report. CMS is now drawing the number of beneficiaries a hospice has from its Provider Reimbursement & Statistical (PS&R) report in order to calculate the per beneficiary cap, Lucas confirmed. Thus hospices no longer have to submit a report to their MAC with that information.

"That's great news," cheered a hospice caller in the forum.