Hospice Reminder: Claims with Anti-Cancer, Anti-Emetics will Process Starting Jan. 4
Hospice Encouraged to Resubmit Previous Bills that Excluded These Drugs
December 19, 2015 09:16 AM
In August, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1528/Change Request 9255, which addresses instances where hospice claims containing certain anti-cancer and anti-emetic drugs have been returned to provider (RTP). Effective January 1, 2016, systems changes will be implemented that will allow all anti-cancer and anti-emetic drugs to process on hospice claims. In the interim, hospices have been instructed to remove codes for these drugs from their claims. Starting in January hospice providers should resume reporting of anti-cancer and anti-emetic drugs.
Both CMS and the Medicare Administrative Contractors (MACs) are encouraging hospices that removed these drugs from their claims so that the claims would process, beginning in early January, to submit claim adjustments for all previous claims that should have included anti-cancer and anti-emetic drugs and that fall within the timely filing period. While it is recognized that this will create additional work for hospice providers, it also means that drug data submitted by way of the hospice claims will be more accurate for purposes of determining drug costs in hospice, which could have some impact on future hospice payment decisions.
For additional information, please refer to the MM9255 article here on the CMS website.