CMS is updating the Medicare Claims Processing Manual to more accurately state the requirements around the cancellation of an election and the data required on institutional claims, along with hospice claims submission clarifications. In MLN Matters 12626, CMS encouraged agencies to “make sure your billing staff knows about these changes.”
 
CR 12626 updates Chapter 11, Sections 20.1.4 and 30.3 of the Medicare Claims Processing
Manual to state current policy more accurately. There’s no new policy. The changes to the manual are as follows:
  • Hospices must use a cancellation notice when the patient isn’t getting services from the
    hospice, but the admission date has already been entered. The entered dates are
    voided since the patient never participated with the hospice. A cancellation notice
    removes the hospice election period created by a Notice of Election (NOE). You can
    also use cancellation notices to remove a transfer or for a change of ownership sent in
    error. When there’s been a transfer or change of ownership, the admittance date on the
    8xD Type of Bill must match the corresponding transfer or change date to make sure
    those dates are removed correctly.
  • Hospices use revenue code 0657 to show hospice charges for services provided to
    patients by physicians, nurse practitioners, or physician assistants employed by the
    hospice; or physicians, nurse practitioners or physician assistants receiving
    compensation from the hospice. Physician services done by a nurse practitioner require
    the addition of Modifier GV with revenue code 0657. Your MAC will pay the lesser of the
    actual charge or 85% of the fee schedule amount when revenue code 0657 is billed with
    Modifier GV. You may report additional revenue codes describing the visits provided
    under each level of care.
  • You must report in line-item detail for all visits related to the palliation and management
    of the terminal illness or related conditions in the home, whether provided by hospice
    employees or under arrangement. All services hospice employees provide in all other
    sites of service, including contract facilities, must also report in line-item detail, except for
    hospice inpatient facilities.
  • You must report all general inpatient care and respite care visits related to the palliation
    and management of the terminal illness or related conditions provided in hospice-owned
    facilities. However, you may report these services as a number of visits in each
    discipline per week, using HCPCS code Q5006.
  • Report the total number of visits for each discipline per week at each location of service
    for general inpatient care you provide in an inpatient hospice facility (Q5006). Each visit
    will represent 1 unit.