CMS Provides Clarification on Rescission of Hospice CR 8273: New CR Anticipated with October 2014 Effective Date
March 7, 2014 10:09 AM
On November 7, 2013, the Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8273. CR8273 instructed Medicare Administrative Contractors (MACs) to implement a new edit to deny hospital inpatient claims when there is a Medicare hospice claim for the same beneficiary within the same covered period and the principal diagnosis code on the hospital inpatient claim is an exact match to any of the hospice claim’s diagnosis codes. The scheduled effective date was April 7, 2014. In late February, CMS issueda rescission of Medlearn Matters article 8273, which accompanied CR 8273.
The National Association for Home Care & Hospice’s Hospice Association of America (HAA) has learned from CMS that the rescission was necessary so that an edit related to the CR could be revised. It is CMS’ expectation that the rescinded CR 8273 will be reissued as CR 8625 at some time in the near future. It will have an effective date in October 2014. This means that rejection of inpatient hospital claims that include one of the hospice diagnoses as the principal diagnosis will not begin in April as previously scheduled, but will begin in October instead.
Policies in CR8625 are expected to reflect those used to develop CR8273.
It should be noted that while this edit is new, it is longstanding Medicare policy that - relative to hospice patients - Medicare only pays separately for hospital inpatient services when those services are not related to the treatment of the terminal condition for which hospice care was elected, as described in Medicare Claims Processing Manual, Chapter 11, Section 50.
If the hospital inpatient services are related to hospice services, CMS considers any payments to the hospital to be overpayments. CR 8273 also instructed the MACs to retroactively review hospital claims with dates of service within three years of the implementation date. It is anticipated that the new CR will contain similar instructions, which will result in the MACs seeking recoupment of overpayments from the billing hospital for any hospital claims that match the edit criteria that are dated within the past three years of the effective date. Hospices are advised that hospitals may then seek payment from the hospice.
HAA suggests that hospices do the following in anticipation of this change:
Review hospital contract language to ensure it addresses the billing procedures between the hospice and the hospital
Review patient consent forms to ensure they address situations where the patient seeks treatment for related conditions that is outside the hospice plan of care and/or does not go through the hospice to arrange the treatment
Review patient admission paperwork to ensure it includes information on hospitals contracted with the hospice for inpatient services and the need for the patient to go through the hospice to arrange care and only utilize the contracted hospital for hospice-related inpatient care
For previous coverage in NAHC Report, please click here.