Home Health & Hospice Week

New missive addresses social worker visits.

Hospices now have a few more clues from the feds on new claims reporting requirements--but stakeholders are calling for additional clarification.

On Nov. 18, the Centers for Medicare & Medicaid Services released additional questions and answers on the new data requirements called for in Change Request 5567 (Transmittal 1304).

Background: Hospices must begin reporting medically reasonable and necessary direct patient care visits made by nurses, social workers, home health aides, physicians and nurse practitioners, along with visit charges, starting next year. The new requirements are optional starting Jan. 1 and required as of July 1, 2008 (see Eli's HCW, Vol. XVI, No. 39).

Key questions addressed in the new Q&As include:

Q. What constitutes a direct patient visit that is medically reasonable and necessary?

A. The feds say they define a medically reasonable and necessary direct patient visit as one that "is reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patient's plan of care."

"As noted [earlier], it is not appropriate to break tasks up into multiple visits for the purpose of inflating the patient's visit count for the day," says CMS.

Q. What constitutes a medically reasonable and necessary social worker visit?

A. When it comes to social workers, "medically reasonable and necessary direct patient visit" is one that is "reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patient's plan of care," the new missive says.

Good news: "[Due to] the nature of a social worker's functions, counseling or speaking with a patient's family or arranging for placement, would constitute a visit," CMS clarifies.

Q. If multiple health care providers are providing care at the same time, does each count as a visit?

A. Yes, says CMS, "as long as the visits are required for the palliation and management of the terminal illness and related conditions" noted in the care plan. But the agency stipulates that providers should not list visits solely "for the purposes of increasing the number of visits."

Resource: To read the full Q&A document, go to www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/downloads/Questions_and_Answers_About_CR5567v2.pdf.