Hospice Claims and Use of Debility, Adult Failure to Thrive, and Dementia Diagnoses
CMS expects that hospices not use ‘debility’ and ‘adult failure to thrive’ as the primary diagnosis on hospice claims effective immediately.
In the April 30, 2013 edition of NAHC Report, a summary was provided for the FY2014 Hospice Wage Index proposal that included some details of the portion of the proposed rule related to multiple diagnoses on hospice claims and specifically hospices’ use of ‘debility’, ‘adult failure to thrive’, and dementia as the principal diagnosis.
CMS indicated that hospices should not use these diagnoses as the principal diagnosis, and that in the future they will return to provider (RTP) claims with ‘debility’ or ‘adult failure to thrive’ as the principal diagnoses. In the CMS Open Door Forum (ODF) on May 8, 2013 CMS indicated that instruction to contractors for RTPing these claims would be coming out soon. No particular date was given but it is clear that CMS has warned providers about the need to RTP claims and that providers should not be coding these diagnoses as the principal diagnosis.
NAHC strongly recommends that all hospices review each case where ‘debility’ or ‘adult failure to thrive’ is listed as the principal diagnosis.