Hospice Series Part 3:
CMS Change Request 8358:
Additional Reporting Requirements; Update on Medicare Part D Issue
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This is the third article in our Hospice series, highlighting the many upcoming changes and issues that hospices are facing. This article will highlight the components of CMS Change Request (CR) 8358 -Additional Reporting Requirements for Hospice Claims and provide preliminary guidance for hospice providers. The "relatedness" issue significantly affects these reporting requirements, in particular as related to the line item billing for prescription injectable and non-injectable drugs.
In addition, we have an update on the Medicare Part D issue which has significant impact on providers, patients, and their families. It is imperative that hospices stay abreast of these evolving issues and take necessary steps to insure that they have processes in place to successfully meet these challenges.
CR 8358 Additional Reporting Requirements for Hospice Claims:
The Highlights of CMS Change Request (CR) 8358-Additional Data Reporting Requirements for Hospice Claims include the following:
Effective Dates:
- January 1, 2014: Voluntary reporting for claims with dates of service on or after 1/1/14. Voluntary claims will be submitted to the Medicare Administrative Contractor (MAC) beginning January 6, 2014.
- April 1, 2014: Mandatory reporting for claims with dates of service on or after 4/1/14.
Additional Reporting Requirements Overview:
- Hospice staff visit data for General Inpatient (GIP) level of care in SNFs and Hospitals:
- Hospices must report all hospice staff nursing, PT, OT, ST, Hospice Aide as well as Social Work (visits and calls) in 15 minute increments for patients in skilled nursing facilities receiving skilled care (site of service HCPCS code Q5004) and hospitals (site of service HCPCS codes Q5005, Q5007, Q5008).
- There are no changes to the GIP visit reporting requirements when the site of service is a hospice inpatient unit.
- NPI Number of Facility where Hospice Patient is Receiving Services:
- Hospices must report the NPI of a nursing facility, hospital and hospice facility where the patient is receiving services when the service is not performed at the same location as the billing hospice's location, regardless of level of care provided.
- If the patient receives service in more than one facility in a month, the hospice must report the NPI of the facility where the patient was last treated.
- Post Mortem Visits:
- Hospices must report the services provided to the patient/family after the patient's time of death if the visits occur on the same calendar day. All visits occurring on the same calendar day of the patient' death after the pronounced time of death will be billed with a PM modifier.
- Visits that occur on a date subsequent to the date of death are not to be reported on the claim.
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