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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/27/16

Clarification Regarding Initial 60-Day Higher Rate for Routine Home Care (RHC) and End of Life Service Intensity Add-On (SIA) Payment Split Between Two Calendar Months

​To: ​Participating Hospice Providers
​Date: ​July 27, 2016
​Re: ​Clarification Regarding Initial 60-Day Higher Rate for Routine Home Care (RHC) and End of Life Service Intensity Add-On (SIA) Payment Split Between Two Calendar Months

 

This notice clarifies the following topics from the January 29, 2016 Informational Notice to hospice providers.

 

·         Routine Home Care (RHC) Two-Tier Payment System

 

The earlier notice stated HFS would calculate the initial 60 days of hospice care effective with dates of service on and after January 1, 2016 and for patients who have hospice elections on file with a begin date on or after January 1, 2016. The Department will actually look back to elections prior to January 1, 2016 to calculate the initial 60 days of hospice RHC. Of the initial 60 days, only services provided on and after January 1, 2016 will be paid at the higher rate.

 

·         End of Life Service Intensity Add-on (SIA) Payment

 

If SIA days cross calendar months, the Department must have the initial month’s claim in payable status before the hospice bills the last claim identifying patient death. The Department will run a monthly report on participants where the following conditions are met:

Ø  The Department received a claim identifying patient death.

Ø  The patient had SIA days in the month of death.

Ø  The patient mathematically could have received SIA days in the previous month.

 

The Department will make payment adjustments for those earlier claims to reimburse the hospice for the SIA days billed on the initial claim. The Adjustment Reason Code appearing on the Remittance Advice for these claims will be 3566 – Service Intensity Add-on Adjustment.

 

Any SIA date must be tied to a date for RHC in order to be reimbursed. Revenue code 0651 (RHC) associated with an SIA day, plus revenue codes 055X (registered nurse service) and/or 056X (social work service), must be billed by individual service date. If there are no SIA days associated with specific RHC days, RHC revenue code 0651 may be billed for multiple service units (FL 46).

 

Patient Status Code editing for the K16 error code – Service Intensity Add-on Billing Invalid – has been revised and the Department will accept any patient status code valid for Medicaid. 

 

Any questions regarding this notice may be directed to a billing consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565.

 

 

Felicia F. Norwood

Director