April 1, 2010, Home Health & Hospice Medicare A Newsline - CGS

In addition, the narrative must reflect the patient’s individual clinical circumstances, and cannot containcheck boxes or standard language used for all patients. The narrative must be composed by the physicianperforming the certification/recertification, and cannot be composed by other hospice personnel.Cahaba has updated its Sample Hospice Certification Form to reflect these new requirements. To view thefinal rule mandating this change, go to the August 6, 2009, Federal Register.(Oct. – Dec. 2009 FAQ)I attended a Cahaba GBA training event where the Hospice Local Coverage Determination (LCD)was covered. Part III of the LCD lists co-morbidities that may support the terminal prognosis of ourpatients. If we list these co-morbidities, aren’t we responsible for the care of these conditions?Listing non-related diagnoses on the claim does not mean the hospice is required to provide care related tothose. The hospice is required to provide care only for the terminal diagnosis and related conditions.Listing diagnosis codes on the UB-04 form does not relate to what care a hospice provider is required toprovide. These co-morbidities can be vital in “painting the picture” of the patient’s true status, andsupporting the terminal prognosis.(Oct. – Dec. 2009 FAQ)Home Health:Some of our patients have a payment source other than Medicare when we begin providing home careservices to them and then they become eligible for Medicare while we are seeing them or theirMedicare benefits may be subsequently activated. How do we bill Medicare when the patientbecomes entitled to Medicare in this situation?There are occasional instances when it is learned that a patient has become entitled to Medicare after thefact, and it is determined that the patient would have qualified for the Medicare home health benefit at thetime of entitlement (under a plan of care by a physician, qualifying skilled need/services provided and thepatient was homebound). When this occurs, a new start of care Outcome and Assessment Information Set(OASIS) assessment must be completed that reflects the date of the beneficiary’s change to this paymentsource. The OASIS items must be completed based on the beneficiary’s condition(s) and needs at the timethe patient was eligible for the Home Health benefit. A new start of care is required any time the paymentsource changes to Medicare Fee-for-Service (FFS). The OASIS is completed in order to obtain a HealthInsurance Prospective Payment System (HIPPS) code and Claims-OASIS Matching Key code, which areneeded to bill Medicare. The OASIS must be submitted to the state for Medicare payment to be made.With that assessment, a Request for Anticipated Payment (RAP) may be sent to Medicare to open an HHPPS episode.For more information about coverage of Medicare home health services, please see the Medicare BenefitPolicy Manual (Pub. 100-2, Ch 7) or the Cahaba Home Health Coverage Guidelines Web page.Instructions for billing home health services to Medicare can be accessed from the Medicare ClaimsProcessing Manual, Pub. 100-4, Ch. 10. You may also need to review the information found in Ch. 25 ofthis manual. Billing instructions are also available on the Cahaba Home Health Claims Filing Web page.(Jan. – Mar. 2010 FAQ)Home Health & Hospice April 1, 2010 37Medicare A Newsline Vol. 17, No. 7