CMS Issues Revisions to Benefit Policy Manual to Reflect FY2015 Payment Rule Changes
Election Form, Revocation, and Attending Physician Requirements Addressed
April 10, 2015 09:25 AM
The Centers for Medicare & Medicaid Services (CMS) recently issued Transmittal 205/Change Request (CR) 9114, which makes changes to Chapter 9 of the Medicare Benefit Policy Manual to reflect hospice regulatory changes put into effect as part of the fiscal year (FY) 2015 payment rule. Specifically, CR9114 revises the manual to provide explicit sections related to the notice of election (NOE), hospice revocation, hospice discharge, and hospice notice of termination or revocation (NOTR) (all of which provide greater detail related to hospice requirements in these areas) and also expands the existing section on attending physician services. These changes are effective May 4, 2015.
The new material, which has been added to the Benefit Policy Manual by way of CR9114, is mostly information that has been supplied by CMS previously in the preamble to the final FY2015 hospice payment rule and in the previously-issued CR8877. However, it is important to note that CMS has included a new requirement that -- as part of the information identifying the attending physician on the election statement -- the hospice must include the physician’s national provider identifier (NPI) number. This is a change from the information CMS included in the final FY2015 payment regulations in that the NPI was referenced as a potential item for identifying the attending physician on the election statement but not explicitly required. The National Association for Home Care & Hospice (NAHC) has concerns that hospices may not have access to the NPI of the attending physician at the time the election statement is signed and that patients may have some concerns about signing a form with empty spaces on it. One option may be to include space for the attending’s NPI in a FOR OFFICE USE ONLY box on the form. NAHC has sought guidance from CMS on this issue, and also as to whether it is appropriate for the hospice to enter the attending physician’s NPI on the form after it has been signed. We will provide any guidance that we receive from CMS in future publications. In the meantime, hospices and vendors are advised to modify their election statements to include space for the NPI of the patient’s chosen attending physician, as well as to educate staff and modify processes to ensure that the NPI of the attending physician is secured and entered onto the election statement in time for the May 4, 2015, effective date. NAHC has also sought additional clarification from CMS regarding requirements related to designation of attending physician for purposes of the hospice benefit and is awaiting response.
Following is a comparison of the existing and revised table of contents.
Changes to Chapter 9 Medicare Benefit Policy Manual
Table of Contents (TOC) under CR 9114
Existing TOC (excerpt)
(Rev. 188, 05-01-14)
(Rev. 205, Issued: 04-03-15)
20.2 - Election, Revocation, and Change of Hospice
20.2 - Election, Revocation, and Discharge
20.2.1 - Hospice Discharge
20.2.1 – Hospice Election
22.214.171.124 – Hospice Notice of Election
20.2.2 - Hospice Revocation
20.2.3 - Hospice Discharge
20.2.4-Hospice Notice of Termination or Revocation
126.96.36.199 - Attending Physician Services
188.8.131.52 - Attending Physician Services
Following are substantive changes that CMS had included as part of the revisions to the Medicare Benefit Policy Manual and the associated content area.
20.2.1 Hospice Election: For this section, CMS has identified information previously included in 20.2 Election, Revocation, and Change of Hospice that is applicable to the hospice election. CMS also includes instruction that the Election Statement must include information identifying the individual’s designated attending physician (with enough detail that the identity of the physician or nurse practitioner (NP) is clear, and must include, at a minimum, the attending’s name and NPI number). The Election Statement must also include acknowledgement that the designated attending is the individual/representative’s choice.
184.108.40.206 Hospice Notice of Election: This section outlines the timely filing requirement related to the Notice of Election (NOE), including the exceptional circumstances under which the hospice’s assigned Medicare Administrative Contractor (MAC) may waive the timely filing requirement.
20.2.2 Hospice Revocation: This section contains information previously included in section 20.2, and no new material has been included.
20.2.3 Hospice Discharge: This section is, in essence, the same as the previous version that was issued in May 2014.
20.2.4 Hospice Notice of Termination or Revocation (NOTR): This section manualizes the requirement for timely filing of the NOTR in cases where the hospice does not submit a final claim within the five-day window.
220.127.116.11 Attending Physician Services:This section has been expanded to contain instruction about including identification and acknowledgement of an individual/representative’s choice of attending on the election statement that is filed with the hospice (as referenced in 20.2.1), as well as provides instruction on the appropriate process to follow when a patient or representative wants to change the designated attending physician (which should be addressed by filing a signed statement with the hospice identifying and acknowledging choice of the new attending). Hospices should note:
(1) CMS is requiring that the chosen attending’s name and NPI be on the election statement that the patient signs
(2) The section also underscores that the effective date of designation of or change in attending physician cannot be earlier than the date that the designation is signed.