Eli's Hospice Insider

Published on Wed Jul 20, 2016 PDF

Here’s why your SIA reimbursement isn’t adding up.

Hospice payment reform continues to take a toll on providers.

In a recent website post, HHH Medicare Administrative Contractor National Government Services provides more detail about why Service Intensity Add-on payments sometimes are not being included on hospice claims when they should be. The Medicare system is not applying the SIA payment to the previous month’s claim when a patient dies within the first few days of a month and: the incoming claim does not contain a qualifying Routine Home Care service; the provider adjusts the original claim to add qualifying (or additional) RN and/or MSW visits; or the provider adjusts the IUR (32G) claim that originally applied the SIA payment, NGS explains.

“NGS is anticipating instructions from CMS in the January 2017 release to correct the Medicare system issue,” the MAC says. Agencies can’t file an adjustment or appeal, because the problem is a system glitch, NGS continues. They just have to sit tight.