Home Health & Hospice Week

Medicare to straighten out start date/admission data snarl.

This summer, Medicare plans to implement the final fix to payment reform-related problems - and simplify your claims data reporting.

The Medicare claims system included a number of glitches relating to payment reform and Routine Home Care and Service Intensity Add-on payments. The Centers for Medicare & Medicaid Services has solved most of those errors, but one still remains.

The problem: The Fiscal Intermediary Shared System can't always identify the number of prior service days from the claim, so the Common Working File "must read data from services provided at other hospices and return additional days that apply to the payment calculation to FISS," CMS explains in MLN Matters article MM10180. When a second hospice bills for services, "the days between the original start date of the benefit period (START DATE 1) and the second hospice's start date (START DATE 2) should be included in the prior service days used in RHC payment calculations." Currently that's not happening.

Medicare has given hospices a workaround for this problem - reporting the benefit period start date as the admission date on your claim in the case of transfers.

The solution: Medicare will implement a system fix that will "identify prior days correctly in transfer situations" and eliminate the need for that workaround. The fix is scheduled for July 2.

See more details at www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10180.pdf.