Home Health & Hospice Week

Not sure how to answer A1400 (Payor Information) in the Hospice Item Set? You’re not alone.

The Centers for Medicare & Medicaid Services isn’t kidding when it says on the HIS form to check all that apply, the National Association for Home Care & Hospice notes in its member newsletter. “Identify all payors that the patient has, regardless of whether or not that payor is expected/likely to provide reimbursement,” CMS says in the HIS Manual. “A1400 should reflect all payors available for healthcare expenses. Healthcare expenses may include services, medications, supplies, and room and board,” CMS told NAHC.

Don’t be surprised if you mark Response J (Self-pay) for many of your patients, even if they’re not paying. “Self-Pay should be chosen even if the patient is not actively paying for anything, but could pay for something or has the funds if needed,” CMS tells NAHC. “Selecting the self-pay response option obligates neither the hospice nor the patient to use those funds to pay for care, should a need to self-pay arise.”

Another pointer: If the patient has a Part D plan, you still choose Response A (Medicare [traditional fee-for-service]), CMS told NAHC, not Response B (Medicare [managed care/Part C/ Medicare Advantage]).

A link to the HIS Manual, with its item-specific response instructions, is at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Item-Set-HIS.html.