Home Health & Hospice Week

HHAs get a preview of wage index transition woes.

If the switch from MSAs to CBSAs for the hospice wage index has left you unsure of how to bill correctly, you aren't alone.

Trade groups and consultants report receiving numerous inquiries from hospices about how to bill under the new Core Based Statistical Areas. CBSAs took effect Oct. 1 with the new fiscal year 2006 rates.

What's at stake: Hospices that use incorrect wage index codes risk having their claims returned to provider (RTP'd) or getting paid at an incorrect rate, warns Abilene, TX-based consultant Bobby Dusek.

Home health agencies can probably expect the same sort of issues to arise when their CBSA transition takes effect Jan. 1, experts predict.

Goodbye MSAs, Hello CBSAs

For hospices, the old four-digit Metropolitan Statistical Area codes are out and new five-digit CBSA codes are in, explains consultant M. Aaron Little with BKD in Springfield, MO.

The Centers for Medicare & Medicaid Services instructs hospices to "submit the CBSA code corresponding to the state and county of the beneficiary'shome in value code 61 on claims that include routine home care or continuous home care," according to Medlearn Matters article No. 3977.

But it's not quite that simple. After industry pressure, CMS agreed to the 50 percent old MSA/50 percent new CBSA transition this year (see Eli's HCW, Vol. XIV, No. 28). That phase-in has given rise to yet another set of wage index codes--the five-digit special hospice wage index code (SHWIC), points out Judi Lund Person with the National Hospice and Palliative Care Organization.

The special codes are a blend of what certain counties would have received had the MSA designations remained in effect and what they will receive under the CBSA designations, CMS explains in the hospice wage index final rule published in the Aug. 4 Federal Register.

Bottom line: Hospices should bill with their new CBSA code, unless they live in a county to which CMS has assigned a new special hospice wage index code, Little instructs. If your county has a SHWIC, you must use that instead of the CBSA code.

Hospices can find their new codes in the final rule or in a special correction to the final rule published in the Sept. 30 Federal Register, CMS directs. The fact that some of the wage index codes came out only one day before going into effect shouldn't distress hospices, says Janet Neigh with the Hospice Association of America. Such late-arriving rates "are not unheard of," she notes.

Pin Down Your Code for Each Patient

Look closely: But it may not be so easy to figure out what your new code is, Little warns. If your urban area listed in Table A of the final rule or your rural area listed in Table B has an asterisk by it, it has a special code instead of the CBSA code. The special codes are listed in Table C of the regulation.

Providers serving patients from rural areas especially need to be on alert, Little cautions. "Because many rural counties now have been given a SHWIC with a unique wage index value, it is critical that hospices pay close attention to the county in which each patient lives in order to know how to properly code the claim and ensure accurate payment."

Some providers could be looking at an array of codes to pick from for patients who live relatively close to one another, Little points out.

Split the bill: Hospices need to remember to split any claims that span the Oct. 1 fiscal year start date, reminds consultant Rose Kimball with Med-Care Administrative Services in Dallas. Providers that fail to split such claims will have all services paid at the lower FY 2005 rate, CMS warns in its Medlearn Matters article. The new CBSA or special codes will apply to services furnished after Oct. 1. 

Note: The Medlearn Matters article is at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3977.pdf. The hospice wage index final rule is at www.access.gpo.gov/su_docs/fedreg/a050804c.html. The correction is at www.access.gpo.gov/su_docs/fedreg/a050930c.html.

For an example of how to determine which hospice wage index code you should use, email executive editor Rebecca Johnson at rebeccaj@eliresearch.com with "wage index example" in the subject line.