Eli's Hospice Insider

Published on Thu Mar 23, 2017 PDF

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Snafus related to billing hospice Routine Home Care high and low levels should be behind you — at least the Centers for Medicare & Medicaid Services hopes so.

The January claims system release should have corrected the last of the RHC payment problems that have persisted since hospice payment reform took effect over a year ago in January 2016, a CMS official told a caller in the Feb. 8 Open Door Forum for hospice providers. “As far as I know the high and low payments should be being made correctly as of today,” he said.

Sticking point: Getting incorrectly paid claims adjusted is another matter, however, the CMS staffer admitted. Medicare has adjusted some claims paid incorrectly due to RHC problems, and is now evaluating how to proceed with correcting the rest. “That’s a little bit tricky, so we’re trying to make sure we get the criteria right and don’t adjust claims we don’t need to adjust and complicate hospices’ accounts receivables more than we need to,” he pledged.

Option: Hospices that have claims “that haven’t been paid correctly and want to submit adjustments now to take care of that, before CMS and the MACs in collaboration figure it out, please do that so you can get your payments corrected,” the CMS source said. However, he acknowledged the caller’s concern that such claims might get accidentally adjusted again when the MACs undertake their second phase of RHC-related adjustments. “You’re getting right at the complication of what we need to figure out,” he told her.

HHH Medicare Administrative Contractor National Government Services notes on its website that corrections for Service Intensity Add-on payment errors were installed Jan. 3. “NGS is awaiting [CMS’] direction on resumption of mass adjustment for these claims. In the interim, providers are advised that they may now adjust any SIA payment issue claims.”

Problem: But hospices that tried to resubmit those claims, as well as claims for Routine Home Care tier mistakes, “have run into processing issues linked to a FISS edit that has been incorrectly returning FY2017 claims with certain CBSA codes that were not valid during FY2016 (but these CBSA codes are valid for FY2017),” the National Association for Home Care & Hospice says. “CMS has directed the MACs to turn this edit off to allow for reprocessing of hospice claims.”

If you resubmit a fiscal year 2017 claim and it’s returned with Reason Code 36458, “the provider should contact the MAC as this is an indication that the edit has not been turned off,” NAHC adds. Meanwhile, an April systems release will attempt to fix the CBSA editproblems.

Other hospice topics addressed in the forum include:

HQRP. If you missed CMS’s Jan. 18 training meeting in Baltimore for the Hospice Quality Reporting Program, you can still benefit from it. CMS has posted the presentations from that training session with answers to practice activities discussed during the meeting. “Also included in the folder for each presentation are the pre-training materials (without answers) and any documents necessary to facilitate exercises used during the training,” CMS notes on the website. Access the presentations and materials via a link at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Quality-Reporting-Training.html in the “Downloads” section.

Pricer update. Along with hospice payment reform last year came a hospice PC Pricer. The software “allows users to keep claims data on a personal computer and run the same Pricer software that is used by the MACs,” a CMS official explained. A link to the updated Pricer for Fiscal Year 2017 is now posted on CMS’s website at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PCPricer/Hospice-PPS-PC-Pricer.html in the “Downloads” box.

CAHPS. Software updates may be giving you trouble logging into the CAHPS data warehouse. If that’s the case, go to the button that says “Need Help With Signing In,” a CMS staffer advised in the forum. That will lead you through the process to create a new password.

Also: You can access the CAHPS Hospice Survey Quality Assurance Guidelines Manual 3.0, which includes technical corrections and clarifications, at www.hospicecahpssurvey.org via a link in the “Current News” menu.