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Home Health & Hospice Week

Hospice:

Consider Correcting Occurrence Code 42 Claims

Published on Thu Nov 01, 2012

More hospice target areas may emerge.If you were unclear on how to use a certain discharge code in 2009 through 2011, it could be landing you on reviewers' radar screens now.A number of hospices that received their PEPPER comparative billing reports this fall found themselves on the high side for the "Live Dis-charges" target area. To calculate that figure, PEPPER report contractor TMF Health Quality Institute divided the numerator (count of beneficiaries discharged alive with occurrence code 42 [date of termination of hospice benefit] and with a length of stay less than 25 days) by the denominator (count of all beneficiaries discharged [by death or alive] with a LOS <25 days excluding discharge patient status code 30 [still a patient], TMF explains in its report definition.Problem: Some hospices were mistakenly using occurrence code 42 for all discharges, they discovered. That caused them to show up in the above-80th-percentile category when [...]
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