Eli's Hospice Insider

Published on Sun Oct 14, 2012 PDF

Have you made these changes that took effect Oct. 1?

With a new fiscal year came more than new payment rates for Medicare hospices.

Hospices saw payment rates increase less than 1 percent on average starting Oct. 1 (see Eli's Hospice Insider, Vol. 5, No. 9 for payment details). Of course, individual agencies' rates of increase vary based on wage data.

But hospices also are facing a new requirement for their claims. Under the 5010 claim format, the field for "other physician," where hospices report the certifying physician, is mapped to three possible physician identifying fields. So hospices need to report the physician info in the 2310F loop of the claim, CMS instructed in a transmittal and MLN Matters article back in April (see Eli's Hospice Insider, Vol. 5, No. 6).

Medicare is requiring the certifying physician's info on the claim when she differs from the attending physician, points out the National Association for Home Care & Hospice.

Oct. 1 also kicked off the data collection period for Medicare's new quality reporting requirements. Hospices must begin collecting data on two quality measures -- pain and the structural/QAPI measure. Hospices must submit the data they've collected in January (see Eli's Hospice Insider, Vol. 5, No. 10).

And hospices must use new 2013 diagnosis codes starting Oct. 1. The Centers for Medicare & Medicaid Services has indicated it will be cracking down on hospices' ICD-9 coding. "Hospice claims which only report a principal diagnosis are not providing an accurate description of the patients' conditions," CMS chastised in the hospice wage index notice published in the July 27 Federal Register. "Providers should code and report coexisting or additional diagnoses to more fully describe the Medicare patients they are treating." (See Eli's Hospice Insider, Vol. 5, No. 9 for more details.)

"If CMS wants diagnosis information to develop a case mix system, hospice coders need to be diligent in coding correctly or the hospice industry will regret any sloppiness in the years to come," cautions coding expert Lisa Selman-Holman with Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.