(Medicare Claims Processing Manual)

 Revenue code 0655 with line item date of service 07/15/XX (for respite period July 15 through 17th) and line item units reported as 3   Revenue code 0651 with line item date of service 07/18/XX (for routine home care on date of discharge from respite through July 31 and line item units reported as 14.  Occurrence Span Codes:    M2 0701XX  07/05/XX   M2 0715XX  07/17/XX   Provider Liability Periods Using Occurrence Span Code 77:  Hospices must use occurrence span code 77 to identify days of care that are not covered by Medicare due to:    Untimely physician recertification.  This is particularly important when the non -covered days fall at the beginning of a billing period other than the initial certification period.   Example:  A new benefit period begins on 6/14/20XX  The hospice is required to obtain the recertification (verbal or written) by 6/16/20XX.  The hospice obtains the recertification 6/19/20XX.   The hospice reports 6/14  6/18 as non- covered days using occurrence span code 77.  The hospice reports the date the certification was actually obtained, 6/19/20XX, in occurrence code 27.  Condition code 85 is only reported in this case because the certification was untimely.    Late- filing of a Notice of Election (NOE).  A timely -filed NOE is a NOE that is submitted to the A/B MAC (HHH) and accepted by the A/B MAC (HHH) within 5 calendar days after the hospice admission date.  When the hospice files a NOE late, Medicare shall not  cover and pay for the days of hospice care from the hospice admission date to the date the NOE is submitted to and accepted by the A/B MAC (HHH).  The date the NOE is submitted to and accepted by the A/B MAC (HHH) is an allowable day for payment.   Example:  Admission date is 10/10/20XX (Fri).  Day 1 = Sat. 10/11/20XX  Day 2 = Sun. 10/12/20XX  Day 3 = Mon. 10/13/20XX  Day 4 = Tues. 10/14/20XX  Day 5 = Weds. 10/15/20XX   10/15/20XX is the NOE Due Date.  IF NOE Receipt date is 10/16/20XX, the hospice reports 10/10-  10/15 as non-covered days using occurrence span code 77 or Medicare systems return the claim to the provider for correction.  Value Codes and Amounts  The hospice enters any appropriate NUBC approved code(s) and the associated value amounts identifying numeric information related to this bill that may affect processing.  Provider -submitted codes:   The most commonly used value codes on hospice claims are value codes 61 and G8, which are used to report the location of the site of hospice services.  Otherwise, value codes are commonly used only to indicate Medicare is secondary to another payer.  For detailed information on reporting Medicare secondary payer information, see the Medicare Secondary Payer Manual.   Code  Title  Definition  61 Place of Residence where Service is Furnished (Routine Home Care and Continuous Home Care)  MSA or Core -Based Statistical Area (CBSA)  number  (or rural  State  code)  of the location  where  the hospice  service is  delivered.   A residence can be an inpatient facility if an individual uses that facility as a place of residence.  It is the level of care that is required and not the location where hospice services are provided that determines payment.  In other words, if an individ ual resides in a freestanding hospice facility and requires routine home care, then claims are submitted for routine home care.   Hospices must report value code 61 when billing revenue codes 0651 and 0652.  G8 Facility where Inpatient Hospice Service is Delivered (General Inpatient and Inpatient Respite Care).  MSA or Core Based Statistical Area (CBSA) number (or rural State code) of the facility where inpatient hospice services are delivered.   Hospices must report value code G8 when billing revenue codes 0655 and 0656.   Medicare- applied codes:  The following codes are added during processing and may be visible in the A/B MAC (HHH)s online claim history.  They are never submitted by the hospice.    Code  Title  Definition  62 Number of High Routine Home Care Days  Days that fall within the first 60 days of a routine home care hospice claim. The Medicare system puts the high days returned by Pricer on the claim as a value code 62 amount.  63 Number of Low Routine Home Care Days  Days that come after the first 60 days of a routine home care hospice claim. The Medicare system puts the low days returned by Pricer on the claim as a value code 63 amount.   If hospice services are provided to the beneficiary in more than one CBSA area during the billing period, the hospice reports the CBSA that applies at the end of the billing period.  For routine home care and continuous home care (e.g., the beneficiarys residence changes between locations in different CBSAs), report the CBSA of the beneficiarys residence at the end of the billing period.  For general inpatient and inpatient respite care (e.g., the beneficiary is served in inpatient facilities in different CBSAs), report the CBSA of the latest facility that served the beneficiary.  If the beneficiary receives both home and inpatient care during the billing period, the latest home CBSA is reported with value code 61 and the latest facility CBSA is reported w ith value code G8.   Revenue Codes   The hospice assigns a revenue code for each type of service provided and enters the appropriate four -digit numeric revenue code to explain each charge.  Hospice claims are required to report separate line items for the level of care each time the level of care changes.  This includes revenue codes 0651, 0655 and 0656.  For example, if a patient begins the month receiving routine home care followed by a per iod of general inpatient care and then later returns to routine home care all in the same month, in addition to the one line reporting the general inpatient care days, there should be two separate line items for routine home care.  Each routine home care l ine reports a line item date of service to indicate the first date that level of care began for that consecutive period.    Code  Description  Standard Abbreviation  0651  Routine  Home  Care  RTN  Home  0652  Continuous  Home  Care  CTNS Home   A minimum of 8 hours of primarily nursing care within a 24- hour period.  The 8- hours of care do not need to be continuous within the 24- hour period, but a need for an aggregate of 8 hours of primarily nursing care is required.  Nursing care must be provide d by a registered nurse or a licensed practical nurse.  If skilled intervention is required for less than 8 aggregate hours (or less than 32 units) within a 24 hour period, then the care rendered would be covered as a routine home care day.  Services provi ded by a nurse practitioner as the attending physician are not included in the CHC computation nor is care that is not directly related to the crisis included in the computation.  CHC billing should reflect direct patient care during a period of crisis and should not reflect time related to staff working hours, time taken for meal breaks, time used for educating staff, time used to report etc.  0655**  Inpatient  Respite  Care  IP Respite  0656**  General  Inpatient  Care  GNL  IP 0657  Physician  Services  PHY  SER (must  be accompanied  by a physician  procedure  code)    ** The date of discharge from general inpatient or inpatient respite care is paid at the appropriate home care rate and must be billed with the appropriate home care revenue code unless the patient is deceased at time of discharge in which case, the appropriate inpatient respite or general inpatient care revenue code should be used.   NOTE:  Hospices use revenue code 0657 to identify hospice charges for services furnished 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.  Procedure codes are required in order for the A/B MAC (HHH) to determine the reimbursement rate for the physician services.  Appropriate procedure codes are available from the A/B MAC (HHH).  Additional revenue codes are reported describing the visits provided under each level of care.    To constitute a visit, the discipline, (as defined above) must have provided care to the beneficiary.  Services provided by a social worker to the beneficiarys family also constitute a visit.  For example, documentation in the medical/clinical record, interdisciplinary group meetings, obtaining physician orders, rounds in a facility or any other activity that is not related to the provision of items or services to a beneficiary, do not count towards a visit to be placed on the claim.  During an initial or comprehensive assessment, it would not be best practice to wait until later (after the clinician has left the home) to document the findings of an assessment or the interventions pr ovided during a patient visit. It is recommended that this information be documented as close to the time of the assessment or intervention as possible. In addition, the visit must be reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patients plan of care.   If a hospice patient is receiving routine home care while residing in a nursing home, the hospice would record visits for all of its physicians, nurses, social workers, and home health aides who visit the patient to provide care for the palliation and mana gement of the terminal illness and related conditions, as described in the patients plan of care.  In this example the nursing home is acting as the patients home.  Only the patient care provided by the hospice staff constitutes a visit.   When making the determination as to whether or not a particular visit should be reported, a hospice should consider whether the visit would have been reported, and how it would have been reported, if the patient were receiving RHC in his or her private hom e. If a group of tasks would normally be performed in a single visit to a patient living in his or her private home, then the hospice should count the tasks as a single visit for the patient residing in a facility. Hospices should not record a visit every time a staff member enters the patients room. Hospices should use clinical judgment in counting visits and summing time.   Hospices report social worker phone calls and all visits performed by hospice staff in 15 minute increments using the following revenue codes and associated HCPCS.  This includes visits by hospice nurses, aides, social workers, physical therapists, occupat ional therapists, and speech- language pathologists   All visits to provide care related to the palliation and management of the terminal illness or related conditions, whether provided by hospice employees or provided under arrangement, must be reported.  The two exceptions are related to General Inpatient C are and Respite care.  CMS is not requiring hospices to report visit data at this time for visits made by non- hospice staff providing General Inpatient Care or respite care in contract facilities.  However, General Inpatient Care or respite care visits rel ated to the palliation and management of the terminal illness or related conditions provided by hospice staff in contract facilities must be reported, and all General Inpatient Care and respite care visits related to the palliation and management of the te rminal illness or related conditions provided in hospice -owned facilities must be reported.   Social worker phone calls made to the patient or the patients family should be reported using revenue code 0569, and HCPCS G -code G0155 for the length of the call, with each call being a separate line item.  Only phone calls that are necessary for the pal liation and management of the terminal illness and related conditions as described in the patients plan of care (such as counseling or speaking with a patients family or arranging for a placement) should be reported.  Report only social worker phone call s related to providing and or coordinating care to the patient and family and documented as such in the clinical records.   When recording any visit or social worker phone call time, providers should sum the time for each visit or call, rounding to the nearest 15 minute increment.  Providers should not include travel time or documentation time in the time recorded for any visit or call.  Additionally, hospices may not include interdisciplinary group time in time and visit reporting.   For dates of service before October 1, 2018, Hospice agencies shall report injectable and non-injectable prescription drugs for the palliation and management of the terminal illness and related conditions on their claims.  Both injectable and non- injectable prescription drugs shall be reported on cla ims on a line -item basis per fill, based on the amount dispensed by the pharmacy.