This change request instructs the CWF and FISS maintainers to deny
an inpatient hospital claim when the principal diagnosis on the inpatient claim
matches one of the hospice diagnosis codes. Services related to a hospice
terminal diagnosis provided during a hospice period are included in the hospice
payment and are not paid separately. An inpatient hospital claim will be denied
when provider’s bill with a condition code 07 on an inpatient claim and the
principal diagnosis on the inpatient claim is found to match one of the hospice
diagnosis codes.
This change was identified by the CMS Recovery Audit Contractors
when they were reviewing payments for inpatient hospital claims related to
hospice patients. The payments
associated with these claims are considered overpayments because the Centers
for Medicare & Medicaid Services do not pay separately for an inpatient
hospital stay when a hospice terminal diagnosis is listed as a principal
diagnosis. The
effective date of this notice is April 1, 2014, but beware that some of the
RACs and ZPICs may go back to review previous years and deny claims.
For more information please use the following
link:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1312OTN.pdf
2 comments:
Does this include physician visit? I was under the impression that the daily physician visits were still covered - ie, visits by the hospice physician or if a hospice is small, then whoever the patient is admitted to at the hospital.
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