Medicare Compliance & Reimbursement

Hospices are better prepared to tackle the new claims data requirement than they were six months ago. But it will still be a major effort for uncertain results, critics say.

Last year, the Centers for Medicare & Medicaid Services set a Jan. 1 deadline for hospices to begin reporting visit data for some of their staff. After a strident outcry from the industry over unanswered reporting questions and other problems, CMS made the data reporting optional until July 1.

"Hospices are more ready now that they were on Jan. 1," judges Janet Neigh with the National Association for Home Care & Hospice. CMS has issued clarifications and more guidance on how to count visits that is helpful to providers.

Hospices welcomed CMS' April announcement releasing them from collecting data on non-hospice staff in inpatient settings, notes the head of billing and collections for a large for-profit hospice based in the Southeast.

"This really was a sigh of relief for many of us," the source says. "It's difficult enough to count direct patient care at the bedside in a setting where rounds are not to be counted as visits."

Eliminating non-hospice staff makes the inpatient visit counting problem "much more manageable," says Judi Lund Person with the National Hospice and Palliative Care Organization.

"Hospices must still count the inpatient visits made by their own personnel," Neigh reminds providers.

Another clarification came from regional home health intermediary Cahaba GBA in a June 23 email to providers. In a recent teleconference on the visit reporting requirements, a hospice asked whether a nurse's visit to pronounce a patient's death counts as a skilled nurse visit.

"Yes," Cahaba answers. "A nurse visit at time of 'death' is to assess the patient's condition to determine if they are deceased and would be a reasonable and medically necessary skilled nurse function."

"Visits after the pronouncement of death would not be reported," the RHHI adds.

Hospices have also had time to work with their software vendors and begin submitting test claims, Person points out. "We are still concerned that test claims are not going through clean for every FI but many providers are working on that issue," Person says.

All for naught? But while hospices are better prepared to report the data, there are still plenty of challenges about the new requirement.

Hospices still must arrive at a per visit charge with fairly limited guidance from CMS. "Do you look at the labor expense and work yourself back to a charge? Do you use your cost report? Do you compute the charges based on expenses where the services took place?" asks the billing and collections manager. "This is the challenge."

New territory: The concept of a visit charge is completely new for many hospices, Person says. "So it has taken them some time to determine the system they will use for determining costs and then charges," she notes.

It's also difficult to count visits during continuous and critical care, the manager maintains.

One of hospices' chief problems with the data collection hasn't changed -- collection of visit data for only some disciplines. CMS wants data for only skilled nursing, social worker, home health aide and physician visits.

"Not all visits from all disciplines are being collected," criticizes hospice attorney Mary Michal with Reinhart Boerner Van Deuren in Madison, WI. "Hospices diligently trying to comply will find the requirements not only burdensome ... but also inconsistent with the hospice model of care."

Only part of the picture: "The data in no way represents the totality of what hospices do," Person stresses. "We are very concerned that it is not comprehensive enough to represent the totality of hospice services."

"The CMS claims data requirements have serious design flaws and will be very challenging for hospices to implement," Michal predicts.

In addition to counting only some disciplines, the visit reporting doesn't account for the duration of visits, Neigh points out. "There is no data on length or complexity of the visit so all counts will not be equal," she says.

"I firmly believe that the data collected, in the current format, will be useless in determining costs of care and future reimbursement," Michal says. "There is great need for a redesign of the data reporting requirements."

Hidden cost: Hospices' efforts to report visits accurately could cost them in cash flow delays, experts warn. If visit numbers change from what a hospice has billed, it must adjust the claim. The only way to avoid the extra work of that adjustment is to delay the billing, the billing manager notes.