Monday 9 September 2013

Hospice Coding Guidelines: New Data Included In Claims Will Affect Pay

In the coming year, the data on your hospice claims that you will submit to Medicare will decide your payment rates in the future. Next year, hospice coding guidelines according to CMS points out additional new data must be included in hospice claims like reporting visit for general inpatient care, facility NPI where care was provided if not at the billing hospice facility, and infusion pumps and prescription drugs.

This step has been taken by CMS as according to many the required claims information is inadequate to determine hospice care

This coming year, Hospices need to report line-item visit data for hospice staff providing GIP to patients in skilled nursing facilities or hospitals with HCPCS code Q5004, Q5005, Q5007 and Q5008, which will also include visits of the nurses, social workers, aides, occupational therapists, physical therapists and language pathologists along with information related to visit and visit length based on line-item. Also, calls and call length also have to be reported that are made by hospice social workers.

Changes are not being made to the GIP visit reporting if the service site is a hospice inpatient unit. Also, there will be no changes for the service of the physician that gets reported in hospice claim. But post-mortem visits for nurses, social workers, aides and therapists need to be reported if it happens on the day of death and billing later on will be impossible because of limitations in claim system.

A PM modifier can be used to mark difference between post-death visits and those that happen before death. Although prescription drugs and infusion pumps can be reported, over-the-counter drugs and other DME items should not be reported.

According to experts, every hospice must start working towards these new guidelines as soon as possible and start reviewing their system of data collection to ensure they achieve the required level of detailing. Also, they need to be familiar with the NDC, pharmacy and DME revenue codes to stay compliant.

Stay updated with all the latest coding and billing changes with online medical coding training conferences only on AudioEducator, where you can choose a wide range of webinars for hospice coding guidelines and long term care coding conference to stay compliant.

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