Home Health & Hospice Week

Medicare has implemented edits that will return your hospice claims submitted with an inappropriate site of service code, contractor National Government Services says on its website.

For Continuous Home Care, claims will return to you if you include these site codes: Q5004 - Skilled nursing facility, Q5005 - Inpatient hospital, Q5006 - Inpatient hospice, Q5007 - Long-term care hospital, or Q5008 - Inpatient psychiatric facility, NGS says.

"These types of facilities typically arerequired to have nursing staff available to perform at a higher level of service, care that would not be found in a patient's home," the contractor explains in a clinical education article. "If a beneficiary resides in this type of facility a CHC level of service would not be appropriate due to the requirements of the facility to provide a higher level of care if the patient's condition warrants it."

For General Inpatient Care, these codes are no-nos: Q5001 - Patients home/residence, Q5002 - Assisted living facility, and Q5003 - Nursing longterm care facility of non-skilled nursing facility.

"These types of facilities typically are not required to provide 'skilled care' as part of the room and board, and often do not meet the staffing requirements for a GIP level of care," NGS says.