Home Health & Hospice Week

MAC issues NCLOS comparative billing report.

Regulators and reviewers are zeroing in on hospices and their patients with non-cancer diagnoses. Find out if you stick out like a sore thumb by using new benchmarks issued by one HHH Medicare Administrative Contractor.

In a new comparative billing report, Palmetto GBA breaks out non-cancer length of stay statistics by diagnosis categories, state, and region. “Provider-specific NCLOS rates allow Palmetto GBA to … focus [on] education and medical review,” among other things, the MAC says in the CBR.

In other words: If your LOS for non-cancer patients exceeds the norm significantly, don’t be surprised to see Additional Development Requests or other scrutiny come your way.

The diagnosis category with the highest LOS across all of Palmetto’s providers for the six months ending Sept. 30 is “Congenital Malformations, Deformations and Chromosomal Abnormalities” with an average of 201 days and 28 percent of patients with a LOS greater than 210 days. But in the Southwest region (Arkansas, Louisiana, New Mexico, Oklahoma and Texas), that jumps up to an average of 280 days.

The next-highest category is “Diseases of the Nervous System” with a 195-day average LOS and 30 percent of patients exceeding 210 days in stay length. Again, the Southwest region has the highest average LOS for the category at 216 days.

Palmetto hospices can obtain their personal NCLOS report, as well as the general reports, on the Palmetto GBA website.