OASIS Alert

Published on Sat Jun 12, 2010 PDF

Watch for new claims edits in July.

This year has already been a busy one for new claim requirements, and the change requests aren't over yet. From itemizing visits to tracking social work phone calls and line item billing for levels of care, if you aren't reporting the details correctly, you could be risking denials.

2010 began with change request 6440 which was effective for service dates on or after Jan. 1. This new claim requirement changed the way hospice visits are reported, requiring line item billing of visits for all service disciplines (nursing, medical social services, and aides) in 15-minute increments, rather than on a weekly basis, says M. Aaron Little, senior managing consultant with BKD in Springfield, MO.

Each visit on a particular day must now be listed individually, Little says. Plus, you must now bill for therapy services performed by direct staff and contract staff addressing the terminal illness.

The change applies to visits provided by hospice employees to patients receiving routine home care,continuous home care, or respite care.

Coming up: Watch for visit reporting for chaplains and volunteers likely to be required in the future, Little predicts.

C.R. 6440 also requires that you report medical social services phone calls for providing care to or coordinating care of a patient for the palliation and management of the terminal illness and related conditions, Little says. Calls that involve counseling the patient's family should also be reported.

These calls must all be described in the plan of care and documented in the clinical record, Little says. Each reportable call should be reported on the claim as a billable visit.

Confusing: This requirement could result in situations where three calls occur in a 20 minute span and you must bill for each call separately, even though they each lasted less than 15 minutes, Little points out.

Want more? Subscribe to Eli's Hospice Insider at www.elihealthcare.com/spec_hospice_insider.htm.