Hospice billings changed

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The Centers for Medicare & Medicaid Services recently updated instructions on coding hospice claims. Billing staffs should be aware of these changes, which went into effect Oct. 1, CMS stated in a memorandum about the Medicare manual update.

A claim should list a principal diagnosis “most contributory” to the patient's terminal prognosis, the memo stated. It identified some unacceptable codes, including “adult failure to thrive.” A number of dementia-related codes are unacceptable, but some under “Diseases of the Nervous System” may be allowed, according to the new instructions.

The new update does not change the policy regarding site-of-service codes, but clarifies when certain codes should be used. Q5003 is for hospice care in a long-term care or non-skilled nursing facility; Q5004 is for a skilled facility. 

There are four listed situations in which Q5004 should be used, including when a person is receiving SNF inpatient respite care.

There also are newly required time frames for submitting information to Medicare Administrative Contractors. 

When a beneficiary elects hospice coverage, a notice-of-election is to be sent to and accepted by a MAC within five business days. If a notice-of-election is not filed in a timely manner, the non-covered days are to be a provider liability.