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Hospice

  1. Question Hospice
    Medical Coding Books
    One of my providers saw a patient in the hospital at 11 AM for a UTI related to the patient's bladder cancer. At 3:50 in the afternoon of the same day, the patient's paperwork was signed admitting him to hospice services. Medicare is denying the service saying that the patient was in hospice on our date of service and the hospice provider is refusing to pay us because our services were provided prior to the "time" that the he was admitted to hospice care. It is my impression that hospice services are per day, not per hour, and that the hospice provider should be repsonsible for this charge. However, I am unable to find any documentation supporting this. Does any one have any advice?

  2. #2
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    Quote Originally Posted by prmiller View Post
    One of my providers saw a patient in the hospital at 11 AM for a UTI related to the patient's bladder cancer. At 3:50 in the afternoon of the same day, the patient's paperwork was signed admitting him to hospice services. Medicare is denying the service saying that the patient was in hospice on our date of service and the hospice provider is refusing to pay us because our services were provided prior to the "time" that the he was admitted to hospice care. It is my impression that hospice services are per day, not per hour, and that the hospice provider should be repsonsible for this charge. However, I am unable to find any documentation supporting this. Does any one have any advice?
    The hospice is incorrect. Once the patient is admitted all services begin on that day...there is no ruling about time of day. The hospice is responsible for the charges. Attached is where the info is located on the CMS website:

    CMS Manual System
    Department of Health & Human Services (DHHS)
    Pub 100-04 Medicare Claims Processing
    Centers for Medicare & Medicaid Services (CMS)
    Transmittal 2326
    Date: October 27, 2011
    Change Request 7556

    Admission/Start of Care Date

    The hospice enters the admission date, which must be the same date as the effective date of the hospice election or change of election. The date of admission may not precede the physician's certification by more than 2 calendar days.
    The admission date stays the same on all continuing claims for the same hospice election.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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