Archive for July, 2014

July 2, 2014

Medicare Updates to the Hospice Manual-Transmittal 188

Medicare provided updates and clarifications to the Hospice Manual with Transmittal 188. Two of those clarifications impact coding. Hospice should no longer be surprised that CMS expects that more than just the terminal illness be coded on the claim. The real trick is to determine what is related and what is not related. Those related diagnoses are placed on the claim along with the terminal illness and hospices are to cover the medications and treatments for those related conditions. This is nothing new, however CMS has determined that it needs enforcement.

Here is the first clarification:

Only care provided by (or under arrangements made by) a Medicare certified hospice is covered under the Medicare hospice benefit.

The hospice admits a patient only on the recommendation of the medical director in consultation with, or with input from, the patient’s attending physician (if any).

In reaching a decision to certify that the patient is terminally ill, the hospice medical director must consider at least the following information:

(1) Diagnosis of the terminal condition of the patient.

(2) Other health conditions, whether related or unrelated to the terminal condition.

(3) Current clinically relevant information supporting all diagnoses.

Notice the attention to other health conditions to substantiate the determination of “terminally ill.”

With a renewed interest in hospice coding, there has been some misinformation regarding what can or cannot be coded by another entity also involved in the patient’s care for unrelated conditions. Here’s what’s covered by the hospice and what’s not…

Hospices obtain election statements from the individual and file a Notice of Election with the Medicare contractor, which transmits them to the Common Working File (CWF) in electronic format. Once the initial election is processed, CWF maintains the beneficiary in hospice status until a final claim indicates a discharge (alive or due to death) or until an election termination is received.

For the duration of the election of hospice care, an individual must waive all rights to Medicare payments for the following services:

1) Hospice care provided by a hospice other than the hospice designated by the individual (unless provided under arrangements made by the designated hospice); and

2) Any Medicare services that are related to the treatment of the terminal condition for which hospice care was elected or a related condition, or services that are equivalent to hospice care, except for services provided by:

a. The designated hospice (either directly or under arrangement);

b. Another hospice under arrangements made by the designated hospice; or

c. The individual’s attending physician, who may be a nurse practitioner (NP), if that physician or nurse practitioner is not an employee of the designated hospice or receiving compensation from the hospice for those services.

Medicare services for a condition completely unrelated to the terminal condition for which hospice was elected remain available to the patient if he or she is eligible for such care.

The last sentence should be engraved in stone.