Monday, September 29, 2008

Insurance Guru: Sending Hospice Visit Data to the Big Bad Wolf (Part 1)

While I was doing some research on Hospice budget cuts and funding for my previous post, I ran across all sorts of FAQ's on the Centers for Medicare and Medicaid Services (CMS) website regarding new Hospice reporting rules. The reason given for this data mining effort?...

"The Medicare hospice benefit was implemented in 1983. Since that time, the benefit has grown considerably. Unlike other payment systems, hospice providers have had to provide minimal information on the hospice claim. The Office of the Inspector General (OIG), the General Accounting Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) all recommended that CMS collect more comprehensive data in order to better evaluate trens in utilization of the Medicare hospice benefit. This additional information will help to provide a better understanding of the types and frequency of hospice services provided during a day of hospice care."

I've worked with provider contracts and their coding for years and in that time, four simple codes have been used for all Hospice billings:

651 - Routine Home Care
652 - Continuous Home Care
655 - Inpatient Respite Care
656 - General Inpatient Care

Remember, Medicare develops the coding and updates happen every year. If they've been getting minimal coding, it's because they've provided minimal coding choices.

Medicare now requires Hospices to provide additional coding to indicate where the patient is being cared for (in the home, in a SNF, etc.) as well as the visits the patients is receiving. Interestingly, they are only requesting data on physicians, nurses, home health aides and social workers. Why? And the answer is:

"We selected the physician, nurse, home health aide and social worker because we have existing revenue codes available to capture this information on the claims. We recognize that this does not represent all care or the items provided under the hospice benefit."

Wait - "we recognize that this does not represent all care or the items provided under the hospice benefit"? Is this some weird alternative universe where it only counts if you can give it a code? Oh yeah... it's Medicare, so it is an alternative universe.

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