Home Health & Hospice Week

Hospice Compare on track for 2017 debut.

If trying to figure out why your hospice payments aren’t reconciling with your billing is driving you crazy, you aren’t alone.

In its July 13 Open Door Forum for home care and hospice providers, the Centers for Medicare & Medicaid Services ran down a list of payment reform-related billing glitches. Some have been fixed or are scheduled for correction this month, while others have had failed corrections and are scheduled for resolution next year.

Fixed: The system does appear to be corrected for a problem in which prior hospice days weren’t being counted for Routine Home Care calculation purposes because a revocation was filed before the final claim, a CMS staffer explained. Hospices had been overpaid due to the error.

Fixed soon: Another problem occurs when the claims system uses days from a prior hospice stay to count toward RHC when they should not count, because it has been more than 60 days since the stay ended. The fix for this problem that underpays hospices is scheduled for July 25, the CMS official told forum attendees.

Long wait: Two other fixes aren’t scheduled until January, however. In one problem, the claims system isn’t applying the correct day count for RHC rate setting. In another, Service Intensity Add-on payments are not being correctly applied, the CMS source explained.

“While changes to correct both of these problems have been completed by the MACs, the changes did not fully address the problems, so additional changes must be made,” explains the National Association for Home Care & Hospice in its member newsletter.

CMS plans to issue a Change Request transmittal detailing the two January corrections in the first week of August. These changes to the system have to go through the “complete system development life cycle, which does tend to take longer” — thus the January implementation, the staffer acknowledged.

Other hospice issues addressed in the forum include:

• Hospice directory. CMS has taken a step toward hospice quality data public reporting. But for now, only a hospice’s name, address, ownership type, CMS Certification Number (CCN), profit status, and date of original CMS certification are available in a new directory at https://data.medicare.gov, a CMS source said in the forum.

“All of the information in the Hospice Data Directory comes from the CMS Automated Survey Processing Environment (ASPEN),” CMS notes in a release about the directory. “If your agency’s data is not listed in the database, is incorrect, or has changed, contact your Regional Office (RO) Coordinator,” the agency instructs.

Watch out: “CMS is actively developing a CMS Hospice Compare site, which it expects to complete sometime in mid-2017,” the agency says in the release. “The CMS Hospice Compare site will provide valuable information regarding the quality of care provided by Medicare-certified hospice agencies by reporting the eligible Hospice Item Set (HIS) quality measures for each agency.”

CMS does plan to give hospices a helping hand with public reporting, at least. “CMS will offer opportunities for stakeholder engagement and education prior to the release of the CMS Hospice Compare site,” it pledges.

• CAHPS. Hospices have until July 29 to file for a reconsideration to their CAHPS reporting status, a CMS official said. CMS mailed hospices notification letters informing them of their Hospice Quality Reporting non-compliance status last month (see Eli’s HCW, Vol. XXV, No. 24).

Hospices that didn’t meet CAHPS and/or Hospice Item Set submission requirements in 2015 will see a 2 percent reduction to their 2017 payment rates. Instructions for the reconsideration request process are in the letters.