Home Health & Hospice Week

CAHPS, Part D problems, and late billing also addressed in Open Door Forum.

You should get relief from Medicare’s inability to support its requirement to bill infusion pumps and other DME — some right away, and some “soon.”

The problem: Starting April 1, the Centers for Medicare & Medicaid Services has required hospices to report a slew of new data, including durable medical equipment like infusion pumps, on their claims (see Eli’s HCW, Vol. XXIII, No. 10). But the claims system has returned “certain claims” in error, admitted CMS’s Wil Gehne in the agency’s July 9 Open Door Forum for home care and hospice providers. Those are claims with infusion pumps, hospices relate.

The solution: CMS is in the process of developing instructions to Medicare Administrative Contractors to override reason codes W7061 and W7072, which are returning those claims, Gehne revealed in the forum.

When the instructions take effect, the override will take place automatically, Gehne explained in the question-and-answer portion of the call. But agencies will have to resubmit claims returned in error previously.

HHH MAC CGS has already announced that it will release such held-up claims, which are located in status location S M7061 and S M7072, within the next two weeks.

If you don’t want to wait for the override process to take effect to claim your rightful reimbursement, you do have another option. Hospices may submit claims stripped of the infusion pump data, then submit an adjustment for the claim later, Gehne confirmed. Each hospice may decide whether to use that option based on what’s best for their business process, he said.

Other hospice-related issues addressed in the forum include:

• CAHPS. The hospice Consumer‑Assessment of Healthcare Providers and Systems‑requirement is coming up fast, but hospices can’t even choose their vendors yet. CMS has just launched the hospice 

CAHPS website at www.hospicecahpssurvey.org, and the agency hopes to post a list of approved vendors by Sept. 1, if not earlier, said CMS’s Debra Dean-Whittaker in the forum.

Reminder: Hospices will participate in a CAHPS dry run in the first quarter of 2015, then begin monthly surveys in April 2015 (see Eli’s HCW, Vol. XXIII, No. 10).

The hospice CAHPS survey will contain 47 questions, Dean-Whittaker said in the Q&A portion of the call. The survey instrument is composed of these measures, the new website notes: Hospice Team Communication, Getting Timely Care, Trea-ting Family Member with Respect, Providing Emo-tional Support, Support for Religious and Spiritual Beliefs, Getting Help for Symptoms, Information Continuity, Understanding the Side Effects of Pain Medication, and Getting Hospice Care Training.

• Part D. Frustration with drug coverage by Part D plans is mounting. Cheryl Sweetin with Carrefour Associates complained to CMS that the 11 hospice locations she manages are having lots of trouble with discharged patients being unable to get Part D plans to pay for their drugs.

Patients being discharged are having a “horrific time” trying to get their drugs after discharge, Sweetin said in the call. “We’re at … our wit’s end, trying to help patients who are discharged to get their meds.”

CMS’s Randy Throndset didn’t offer any solutions, but noted that the agency’s Part D staffers have been receiving complaints and questions related to the requirement.