CMS Issues Change Request for Demand Billing of Hospice General Inpatient Level of Care
August 1, 2013 09:36 AM
On July 26, the Centers for Medicare & Medicaid Services (CMS) issuedChange Request (CR) 8371regarding Demand Billing of Hospice General Inpatient (GIP) Level of Care. CR 8371 instructs hospices on preparing demand bills when GIP is denied and the routine home care rate is applicable. It also instructs the Medicare Administrative Contractors (MACs) on reviewing and processing demand bills. CR 8371 clarifies current policy and contains no changes in policy. The effective date is January 1, 2014, with an implementation date of January 6, 2014.
When a Medicare hospice beneficiary has been receiving covered GIP and the hospice determines that continues care at that level is not reasonable and medically necessary, the hospice must issue an Advanced Beneficiary Notice of Non-coverage (ABN) if the beneficiary wants to continue receiving that level of hospice care.
Billing instructions for demand bills associated with ABN issuance are contained inChapter 1 (General Billing Requirements) of the Claims Processing Manualin section 60.4.1 Outpatient Billing with an ABN (Occurrence Code 32). The hospice reports occurrence code 32 on the claim with the date the ABN was provided to the beneficiary and submits the services as covered services with a GA modifier to the line item(s) related to the ABN.
Medicare may require suspension of any claims using occurrence code 32 for medical review of covered charges associated with an ABN. If the MAC makes a determination of non-coverage, the MAC must non-cover the GIP line item(s) on the claim. Hospices may be paid the routine home care (RHC) rate in lieu of the denied GIP service. In the absence of hospice-submitted RHC line items, the MAC will add a line item for the RHC base rate for each denied GIP line.
Medicare systems will allow a hospice claim with GIP and RHC reported with the same line item date of service when at least one of the line items is non-covered. A MedLearn Matters article related to CR 8371 is availablehere.