Eli's Hospice Insider

Published on Fri Dec 22, 2017 PDF

You'll need to proceed on a claim-by-claim basis.

It's not too late to secure payment adjustments caused by payment reform changes.

The window to submit a list of claims needing hospice payment reform billing has closed (see Eli's Hospice Insider, Vol. 10, No. 11). But you can still secure payment adjustments individually, HHH Medicare Administrative Contractor CGS says on its website.

"If you did not submit a list of claims to correct the RHC and SIA payment errors, (not related to transfers) you may proceed and submit your own adjustment now," CGS says.

Reminder: "The two-tiered payment rate for RHC services ... allowed a higher RHC rate for days 1 through 60, and a lower RHC rate for days 61 and beyond," CGS says. "In situations where there was a transfer within the benefit period, the RHC visits were overpaid because the days prior to the transfer were not recognized."

In those cases, hospices can enter "Start Date 1" of the current benefit period as the admission date on the claim, rather than their own admission date, CGS instructs. "This will allow all the days in the period to be counted in the RHC payment calculation," the MAC says.

Then: "Add Condition Code D9 and submit a message in the Remarks field" reading "Adjust due to RHC errors SE17014," CGS says.

Note: See more detailed instructions at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17014.pdf.