CMS Signals Intent to Rescind CR8098 on Vaccines for Hospice Patients
December 12, 2013 10:00 AM
As reported earlier this year – please see NAHC Report, October 22, 2013 and NAHC Report, May 15, 2013 - the Centers for Medicare & Medicaid Services (CMS) issued Change Request 8098, under which edits to the Medicare systems would, effective October 1, 2013, deny claims for vaccines furnished to hospice patients that were provided by anyone other than the patient’s hospice provider. This policy raised numerous questions within the stakeholder community, and prompted NAHC’s Hospice Association of America (HAA) to submit several questions to CMS about the policy.
HAA recently received word from CMS that based on review of the policy they have found “no support for it in other regulations and instructions,” and conveying CMS’ intent to rescind CR 8098 as soon as possible. CMS is currently determining how soon they can reverse the edits within the systems that are currently disallowing claims for vaccines from providers other than hospices.
Once the edits required under CR8098 are disabled, it will remain the case that hospice providers who want to bill separately for vaccines will be requires to bill under Part B. CMS has, however, indicated a willingness to discuss this issue further.
Following is a question submitted by HAA to CMS, along with CMS’ responses:
NAHC/HAA: Change Request 8098 has raised numerous questions among hospice providers and other stakeholders. We are aware that CMS has provided some guidance on this issue, but we are seeking additional clarification on CMS policies to ensure that we provide the proper information to interested parties.
While we are aware that the Claims Processing Manual (Manual) has for some time included instructions indicating that hospices “can provide the influenza, pneumococcal, and hepatitis B vaccine to beneficiaries who request them including those who have elected the hospice benefit,” we are not familiar with any instructions that have prohibited reimbursement for these vaccines to the hospice patient’s attending physician or to another immunizer. Would it be possible for CMS to provide that information to us?
CMS: The same section (Pub. 100-04, ch. 18, section 10.2.4) goes on to say “These services may be covered when furnished by the hospice.” CR 8098 interpreted this passage to mean ‘may only be covered,’ limiting the decision on the appropriateness of the vaccination for the hospice patient to the hospice, to ensure appropriate care coordination. CMS has re-visited this interpretation, finding no support for it in other regulations and instructions.
We plan to rescind CR 8098 as soon as possible. We are determining the earliest date the Common Working File edits created by this CR can be disabled. We will provide more details about this via provider education listservs.