CMS Enforces Hospice Respite Level of Care Requirements
February 11, 2014 08:30 AM
Late last week, CMS released Change Request (CR) 8569 - Enforcement of the 5 day Payment Limit for Respite Care Under the Hospice Medicare Benefit. New edits are being implemented to prevent payment of respite care for more than 5 days at a time for any hospice claim submitted on or after July 1, 2014. CMS will Return to Provider (RTP) any claim received after this date that has more than 5 units per episode of respite care. This does not mean that hospices cannot provide and bill for this level of care more than once per month or benefit period. It means the hospice cannot submit a claim for respite care that exceeds 5 days per occurrence. The CR revises Section 30.3 of the Medicare Claims Processing Manual, Chapter 11 to reflect this requirement.
CMS adds the following to this Section:
Respite care is payable only for periods of respite up to 5 consecutive days. Claims reporting respite periods greater than 5 consecutive days will be returned to the provider. Days of respite care beyond 5 days must be billed at the appropriate home care rate for payment consideration.
For example: If the patient enters a respite period on July 1 and is returned to routine home care on July 6, the units of respite reported on the line item would be 5 representing July 1 through July 5, July 6 is reported as a day of routine home care regardless of the time of day entering respite or returning to routine home care.
When there is more than one respite period in the billing period, the provider must include the M2 occurrence span code for all periods of respite. The individual respite periods reported shall not exceed 5 days, including consecutive respite periods.
For example: If the patient enters a respite period on July 1 and is returned to routine home care on July 6 and later returns to respite care from July 15 to July 18, and completes the month on routine home care, the provider must report two separate line items for the respite periods and two occurrence span code M2, as follows:
Revenue Line items:
Revenue code 0655 with line item date of service 07/01/XX (for respite period July 1 through July 5) and line item units reported as 5
Revenue code 0651 with line item date of service 07/06/XX (for routine home care July 6 through July 14) and line item units reported as 9
Revenue code 0655 with line item date of service 07/15/XX (for respite period July 15 through 17th) and line item units reported as 3
Revenue code 0651 with line item date of service 07/18/XX (for routine home care on date of discharge from respite through July 31 and line item units reported as 14.
Occurrence Span Codes:
M2 0701XX –0705XX
M2 0715XX –0717XX