Home Health & Hospice Week

These 3 tips can get you off to a good start.

You have until the summer to begin reporting additional hospice claim data to the feds, but it's not too soon to start calculating numbers.

"There's little guidance in [Transmittal 1304] specific to the charge per visit calculation," says Tim Grunwald, finance director for Harbor Hospice in Muskegon, MI. "The question is, what should hospices consider when coming up with that important number?"

Background: Until recently, Medicare kept claims simple for hospice providers, requiring only a small number of service lines to report the number of days at each of the four hospice levels of care. Starting this year, CMS began requiring hospices to report the site of service, and now CMS has stepped up its effort to make the services hospices provide "more transparent" with the new data requirements (see Eli's Home Care Week, Vol. XVI, No. 39).

For claims with dates of service on or after July 1, 2008, hospices must stipulate the number of visits each beneficiary received, as well as an estimated dollar amount representing the cost to provide each visit. Hospices may begin reporting the data as early as Jan. 1, on a voluntary basis.

Challenge: Because hospices don't charge per visit, they don't have that information readily available, says Janet Neigh of the National Association for Home Care & Hospice.

To help hospices come up with estimates that reflect costs specific to the visits, NAHC's Home Care & Hospice Financial Managers Association is working on a formula to guide calculations. The information will be "widely disseminated" once it is complete, most likely early in 2008, Neigh tells Eli.

Do The Math

In the meantime, hospices should take these three steps to begin sizing up costs related to the provision of "direct care" visits.

1. Consult the cost report. This form will be a valuable tool for hospices as they look for a starting point for the charge per visit figure, says Neigh.

2. Factor in indirect costs. Ask yourself what goes into each visit behind the scenes, suggests Grunwald. "The final figure can't just convey the cost of a nurse getting into her car and spending time with a patient," he cautions.

Rather, the cost of providing a direct care visit must factor in time spent on interdisciplinary planning, consultation with a patient's family members and many other factors, says Grunwald.

3. Count on variance. Not every hospice will submit the same cost for a visit by a certain discipline, cautions Neigh. "Variance in the numbers will be natural, depending on a number of questions," she explains. "Where are you geographically, for example? "What focus does your program reflect?"

Resource: For more information on the additional reporting requirements, including CMS' latest Q&A clarifications, go to www.cms.hhs.gov/center/hospice.asp. To read the revised Transmittal 1304 (Change Request 5567), go to www.cms.hhs.gov/Transmittals/2007Trans/list.asp.