Eli's Hospice Insider

Published on Tue Apr 26, 2011 PDF

Plus: CMS ramping up hospice complaint surveys, concurrent care demonstrations, and more.

Do you provide services that aren't related to your patients' terminal diagnoses? If you answered "Yes," then you'd better beef up your documentation if you hope to get reimbursed for those services.

Under Medicare payment rules, the hospice per diem payment rate does not have to cover services that are unrelated to the terminal diagnosis for the patient. But regional offices (ROs) for the Centers for Medicare & Medicaid Services are seeing "misunderstandings" about what fits into that category, CMS's Lori Anderson said at the National Association for Home Care & Hospice's March on Washington conference March 28.

"A terminal diagnosis is not one ICD-9 code," Anderson emphasized to attendees. At the end of life, "almost everything" is related to the terminal condition. "It's the exception and not the norm if it's not related," she said.

The ROs are seeing cases where hospices classify anything not related to one ICD-9 code -- the patient's primary diagnosis -- as unrelated, and thus not subject to payment coverage by the hospice rate, Anderson explained.

The ROs and HHS Office of Inspector General are seeing this problem among nursing home patients, in particular, Anderson said. "It's a good thing that nursing home patients get hospice," she asserted. But payment must follow the Medicare rules.

One hospice provider insisted that the policy is a departure from CMS's previous guidance. The policy is not a departure, Anderson maintained.

Other hospice-related issues discussed at NAHC's conference include:

CMS is still designing that demo, said CMS's Cindy Massuda in the conference. The next step will be a Federal Register notice of solicitation. If funding comes through in the 2012 budget, the program will hopefully launch then, Massuda said.

One example: Recently, a hospice underwent a survey with an immediate jeopardy finding because a nurse was adjusting a hospice patient's medicine dosages on her own, with the patient becoming unresponsive and dying, Roche related.

Resource: If you'd like to see how CMS trains its surveyors, check out http://surveyortraining. cms.hhs.gov, Roche suggested.

ACA requires CMS to implement hospice payment reform "not earlier than 2014," Anderson noted. Right now, CMS is collaborating with the HHS Assistant Secretary for Planning and Evaluation office on analyzing billing data, she said.

Next CMS plans to convene a Technical Expert Panel this summer and develop a preliminary analytic approach to reform, Anderson said. The Medicare Payment Advisory Commission has already recommended a U-shaped payment model -- higher payment at the beginning and end of episodes, lower payment in the middle -- she pointed out. But CMS has not yet decided whether to adopt MedPAC's approach.