Eli's Hospice Insider

Published on Tue Dec 22, 2015 PDF

Polish your Hospice Item Set skills with new CMS tools.

Make sure your Hospice Item Set submission is in good shape, or you’ll have the same payment reduction that hundreds of hospices have incurred for 2016.

Reminder: The Centers for Medicare & Medicaid Services required hospices to begin reporting Hospice Item Set data for all admissions July 1, 2014 and later, or face a 2 percent payment reduction in 2016.

CMS has finalized its payment determinations, including reconsideration requests, for FY 2016 (based on the July 1-Dec. 31, 2014 reporting period), said CMS’s Michelle Brazil in the Nov. 4 Open Door Forum for hospice and home care providers. About 92 percent of hospices met quality reporting requirements (3,712 providers), while 8 percent (322 providers) did not and are subject to the pay reduction, Brazil reported.

Tip: Monitor the final validation reports for your HIS submissions to be sure they went through, Brazil urged. If there is no final validation report or the report contains fatal errors, you must resubmit the data.

Resource: You can obtain HIS help with four new CMS training modules that cover HIS submission, top HIS submission errors, and more. The modules are in the top of the Downloads box at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-QualityReporting/HIS-Technical-Information.html. Other hospice topics addressed in the forum include:

• SIA payments. You won’t have to do anything extra to receive your Service Intensity Add-on payments come Jan. 1, even if the SIA period spans two claims.

Question: One hospice caller asked about SIAs when a patient dies Feb. 2, for example, but no hospice visits were furnished in the days leading up to the date of death on the January or February claim. “How does hospice claim those” SIA payments, the hospice inquired.

Answer: In such a case, the hospice doesn’t need to take any action, assured CMS’s Wil Gehne in the forum. When the February claim is processed, the Medicare claims system will identify the seven-day SIA period extended back into the prior claim and will trigger an automatic adjustment, he explained.

• CAHPS. If you want to change your CAHPS vendor, you can’t do it any old time. You must wait until the beginning of the quarter, advised CMS’s Lori Tiechmann in the forum.

Resources: More information on hospice CAHPS, including the updated CAHPS Hospice Survey Quality Assurance Guidelines V2.0 and slides from the 2015 CAHPS Hospice Survey Training session, are online at www.hospicecahpssurvey.org.