Subscribe to RSSHealthDataInsights (HDI), the RAC for Region D, has posted two approved issues related to hospice. RACs must submit an issue to CMS for approval before it can conduct an automated (without a medical record) or complex (with a medical record) review. CMS has approved two issues related to hospice for HDI to begin reviewing in all of the states in Region D
The name of the first issue is “DME while in hospice” and its description is as follows: “Services related to a Hospice terminal diagnosis provided during a Hospice period are included in the Hospice payment and are not paid separately.” The claims to be reviewed are of DME providers paid on or after October 1, 2007. The RAC will review DME claims to determine whether payment was made for services provided to hospice patients that were related to the patient’s terminal diagnosis and therefore paid for in the hospice’s per diem rate.
The name of the second issue is “Hospice Related Services - B” and its description is exactly the same as the first issue. Part A and Part B provider claims paid on or after October 1, 2007 are included in the review in all states in RAC Region D. The RAC will be reviewing claims of services provided to hospice patients to ensure that no payment was made to any provider for services that were related to the patient’s terminal illness and therefore included in the hospice per diem rate.
Now that HDI has these two issues approved, it is only a matter of time before the other three RACs receive approval for them as well.
HDI covers 17 States and three territories, including: Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa, and Northern Mariana.
What constitutes a dme payment when hospice pays per diem for a basket of goods to choose from if at all?
The line seperating treatments for the terminal diagnosis from other presenting conditions is almost always grey. But the real issue is whether the treatment was generated by the hospice care plan. Other providers often disregard the hospice and provide cares, then bill for them, recieve payment (70%) or recieve denials (30%) and seek payment then from the hospice and or the patient family. This later treend creates hardship and stress. Usually write offs occur.
Eliminate the provision for comfort care in part B.
Eliminate repeated part b stays post hospitalization.
Penalize providers that experience numerous readmissions in their Er’s , etc.
Reinforce hospice and palliative care by giving them more responsibility (case management) post discharge…even for patients at risk who have not given informed consent for hospice care.
In competitive markets patients and their surrogates demand full service. Is there a way to avoid this adversarial process?