Some Hospices Receiving SIA Payments Incorrectly
February 2, 2016 01:59 PM
Effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system under which hospices receive one of two per diem rates (high or low) for Routine Home Care (RHC) and may be eligible for Service Intensity Add-on (SIA) payments when Registered Nurse and Social Work service visits are provided during the last seven days of a patient’s life and the patient is cared for at the RHC level. Hospice providers are just beginning to submit claims for services provided during January 2016. The National Association for Home Care & Hospice (NAHC) has received notice from one of the Home Health/Hospice Medicare Administrative Contractors (MACs) that some hospice providers are receiving incorrect SIA payment adjustments related to services provided at the Continuous Home Care (CHC) level of care. As a result, these hospice providers may be receiving overpayments for some of the care days they have billed.
It is believed that this is a nationwide issue, and the processing error has been reported to the Fiscal Intermediary Shared System (FISS) Maintainer. The issue is expected to be corrected with a system fix scheduled for implementation on February 22, 2016. No provider action is required.
NAHC will provide updates on this issue as they become available through future NAHC Report articles and on its member listserv.