Tuesday, November 19, 2013

Inpatient Hospital Billing for Hospice Patients

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:

Anonymous said...

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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