Wednesday, October 1, 2008

Insurance Guru: Sending Hospice Visit Data to the Big Bad Wolf (Part 2)

So Medicare is insisting on all sorts of visit data from Hospices...

This brings to mind the sweeping coding changes that Medicare launched several years ago for Skilled Nursing Facilities. They moved from 6 simple revenue codes to 50+ "RUGS" rates. RUGS stands for Resource Utilization Groups and the codes are things like RUX, SE3 and RMC. Sounds like we've stepped into a Dilbert cartoon or found a new rap star!

I've yet to work for an insurance company that could automate the payment mechanism for the RUGS calculations. To start with - it's system suicide to replace numeric codes with alpha characters. Thankfully, we didn't have many contracts based on Medicare reimbursements. We still use the simple 6 revenue codes in the contracts offered to our providers.
Check out this article for an exercise in "quantum RUGS mathematics".

Take the approaching Hospice funding cuts, add the data scavenger hunt and you will see Medicare revamping all Hospice billing in an attempt to save money. Of course, Medicare in their perverse, logical fashion will attempt to convice the Hospices that all their number crunching and new, magic codes will get the hospices more money.

I think it will look something like this:

Code VC98.^*347 - Respite care in the home not to exceed 3 hours for ambulatory patients that like to dress in blue. For patients in other colors see code VC98.^*348 and above. For non-ambulatory patients see coding that begins with nine million and above. For more than 3 hours, too bad.

Code ZB.,;) - Inpatient care per day. Anywhere. This is it - all you get. Don't care what services you provide.

Code JUS24?& - Routine home care - per 15 minutes for patients with dentures.

Code JUS25?& - Routine home care - per 15 minutes for patients with houseplants.

Code JUS26?& - Routine home care - per 15 minutes for patients that live less than 10 miles away.

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