Summary of Changes Found in CR 8358

This is an abbreviated summary of the changes highlighted in The Centers for Medicare & Medicaid Human Services Change Request 8358. The full document is available on the CMS website and should be referenced for all official FAQ's in regard to any updates. The purpose of this blog is to restate and simplify what was highlighted as a major change to the existing documentation. It is not a substitute for referencing the entire document, but can be used as a companion to the original text. Text taken directly from the CMS website is located inside quotation marks, and the author's own commentary outside of the quotation marks.

Services provided on or after January 1, 2010, hospices must report social worker telephone calls as well as visits by staff other than the General Inpatient care using the accepted15 minute increments, by utilizing the accepted revenue codes and HCPCS.

As found in CR 8358: "Hospices shall report line-item data for hospice staff providing general inpatient care (GIP) to hospice patients in skilled nursing facilities or in hospitals for claims with dates of service on or after April 1, 2014. Hospices may voluntarily being this reporting as of January 1, 2014. This includes visits by hospice nurses, aides, social workers, physical therapists, occupational therapists, and speech-language pathologists, on a line-item basis, with visit and visit length reported as is done for the home levels of care. This also includes certain calls by hospice social workers…"

The Revenue Code Reporting has also been updated for claims on or after April 1, 2014. On the CMS website, it is available in table format; here is a simple summarization of the changes made.

0250 Non-injectable Prescription Drugs do not have a code (N/A) and require reporting "on a line-item basis using revenue code 0250 and the National Drug Code (NDC). The NDC qualifier represents the quantity of the drug filled, and should be reported as the unit measure." This means the drug, however many milliliters, milligrams, grams, grains etc. absolutely must be notated and entered in the line-item bases PER FILL.

029X Infusion Pumps do have an applicable HCPCS. "Report on the claim on a line-item basis per pump order and per medication refill, using revenue code 029X for the equipment and 0194 for the drugs along with appropriate HCPCS." Every pump, as well as every refill per each medication must be reported appropriately.

0636 Injectable Drugs also have an applicable HCPCS. "Report on a line item basis per fill with the units representing the amount filled. (i.e. Q1234 Drug 100mg and the fill was for 200mg, units reported = 2)." Close attention to detail must be paid here, as a simple typographical error could erroneously change that quantity reported into 100 times what it should be!

Several updates also apply toward line item reporting for general inpatient care. "General inpatient care provided by hospice staff requires line item visit reporting in units of 15 minute increments when provided in the following sites of service: Skilled Nursing Facility (Q5004), Inpatient Hospital (Q5005), Long Term Care Hospital (Q5007), Inpatient Psychiatric Facility (Q5008)."

"The following modifier is required reporting for claims with dates of service on or after April 1, 2014: PM- Post mortem visits. Hospices shall report visits and length of visits (rounded to the nearest 15 minute increment), for nurses, aides, social workers, and therapists who are employed by the hospice, that occur on the date of death, after the patient has passed away. Post mortem visits occurring on a day subsequent to the date of death are not to be reported. The reporting of post-mortem visits, on the date of death, should occur regardless of the patient's level of care or site of service." As long as the visit by a staff member occurs on the date of death, and not after that time, it is to be reported in the accepted 15 minute intervals. Visits after the date of death are NOT to be reported.

"Hospices shall report the NPI (National Provider Identifier) of any nursing facility, hospital, or hospice inpatient facility where the patient is receiving hospice services, regardless of the level of care provided when the site of service is not the billing hospice. The billing hospice must obtain the NPI for the facility where the patient is receiving care and report the facility's name, address and NPI on the 837I version 5010A2 of the electronic claim record on loop 2310 E Service Facility Location. When the patient has received care in more than one facility during the billing month, the hospice shall report the NPI of the facility where the patient was last treated. Failure to report this information for claims reporting place of service HCPCS Q5003 (long term care nursing facility), Q5005 (inpatient hospital), Q5007 (long term care hospital) and Q5008 (inpatient psychiatric facility) with dates of service on or after April 1, 2014, will result in the claim being returned to the provider." The location where the patient has received care most recently (especially if they have changed locations where they are receiving care within the billing month), is reported with the NPI, as well as the facility's name and address. Otherwise, the claim will be returned unpaid to the provider.

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The full PDF file is available Here.