evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
When a facility (hospital, SNF, NF, or hospice inpatient facility) uses a medication management system where each administration of a hospice medication is considered a fill for hospice patients receiving care, the hospice shall report a monthly total for each drug (i.e., report a total for the period covered by the claim), along with the total dispensed.  Hospices shall report multi- ingredient compound prescription drugs (non -injectable) using revenue code 0250.  The hospice shall specify the same prescription number for each ingredient of a compound drug according to the 837i guidelines in loop 2410.  In addition, the hospice shall provide the NDC for each ingredient in the compound; the NDC qualifier represents the quantity of the drug filled (meaning the amount dispensed) and shall be reported as the unit measure.   When reporting prescription drugs in a comfort kit/pack, the hospice shall report the NDC of each prescription drug within the package, in accordance with the procedures for non-injectable prescriptions.   Hospice agencies shall report infusion pumps (a type of DME) on a line -item basis for each pump and for each medication fill and refill.  The hospice claim shall reflect the total charge for the infusion pump for the period covered by the claim, whether the hospice is billed for it daily, weekly, biweekly, with each medication refill, or in some other fashion.  The hospice shall include on the claim the infusion pump charges on whatever basis is easiest for its billing systems, so long as in total, the claim reflects the charges for the pump for the time period of that claim.  Effective for dates of service on and after 10/1/2018, hospices are no longer required to          report drugs using line item detail.  Hospices may report summary charges for drugs as shown in the table below.  Hospices must enter the following visit revenue codes, when applicable:
(Medicare Claims Processing Manual)
Hospices must enter the following visit revenue codes, when applicable:   Revenue Code  Required HCPCS  Required Detail  0250 Non -injectable Prescription Drugs  N/A Required detail:  Report on a line -item basis per fill, using revenue code 0250 and the National Drug Code (NDC).  The NDC qualifier represents the quantity of the drug filled, and should be reported as the unit measure.  For dates of service on and after 10/1/2018: Report a monthly charge total for all drugs (i.e., report a total charge amount for the period covered by the claim) using revenue code 0250.  029X Infusion pumps  Applicable HCPCS
(Medicare Claims Processing Manual)
N/A  Required detail:  Report on the claim on a line -item basis per pump order and per medication refill, using revenue code 029X for the equipment and 0294 for the drugs along with the appropriate HCPCS.  For dates of service on and after 10/1/18: Report a monthly charge total for infusion DME (i.e., report a total charge amount for the period covered by the claim), including DME infusion drugs, using revenue center 029X for the infusion pumps and 0294 for DME infusion drugs.  042x Physical Therapy  G0151 or G0157 Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  043x Occupational Therapy  G0152 or G0158 Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  044x Speech Therapy  Language Pathology G0153  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  055x Skilled Nursing G0154  (before 01/01/2016))  G0299 or  G0300 (on or after 01/01/2016)  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  056x Medical Social Services  G0155  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  0569 Other Medical Social Services  G0155  Required detail:  Each social service phone call is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim
(Medicare Claims Processing Manual)
the HCPCS description.  0569 Other Medical Social Services  G0155  Required detail:  Each social service phone call is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the call defined in the HCP CS description.  057x Aide  G0156  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier the total time of the visit defined in the HCPCS description.  0636 Injectable Drugs  Applicable HCPCS  Required detail: Report on a line item basis per fill with units representing the amount filled. (i.e., Q1234 Drug 100mg and the fill was for 200 mg, units reported = 2).  For dates of service on and after 10/1/2018: Revenue code 0636 is not required.
(Medicare Claims Processing Manual)
Visits by registered nurses, licensed vocational nurses and nurse practitioners (unless the nurse practitioner is acting as the beneficiarys attending physician) are reported under revenue code 055x.   Charges associated with the reported visits are covered under the hospice bundled payment and reflected in the payment for the level of care billed on the claim.  No additional payment is made on the visit revenue lines.    The contractor shall use the following remittance advice messages and associated codes when bundling line items under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Four.  Group Code: CO  CARC: 97  RARC: N/A  MSN: N/A  Effective January 1, 2016, Medicare requires hospices to use G0299 for direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting and G0300 direct skilled nursing of a licensed practical nurse (LPN) in the home heal th or hospice setting. G0154 is retired as of 12/31/2015.  Hospices should report in the unit field on the line level the units as a multiplier of the visit time defined in the HCPCS description.    For information regarding the billing requirements for Coverage of Kidney Disease Patient Education Services under hospice see Chapter 32, 20.1).     HCPCS/Accommodation Rates/HIPPS Rate Codes   Hospices must report a HCPCS code along with each level of care revenue code (651, 652, 655 and 656) to identify the type of service location where that level of care was provided.  The following HCPCS codes will be used to report the type of service location for hospice services:   HCPCS Code  Definition  Q5001  HOSPICE CARE PROVIDED IN PATIENT'S HOME/RESIDENCE  Q5002  HOSPICE CARE PROVIDED IN ASSISTED LIVING FACILITY  Q5003  HOSPICE CARE PROVIDED IN NURSING LONG TERM CARE FACILITY (LTC) OR NON -SKILLED NURSING FACILITY (NF)  Q5004  HOSPICE CARE PROVIDED IN SKILLED NURSING FACILITY (SNF)  Q5005  HOSPICE CARE PROVIDED IN INPATIENT HOSPITAL  Q5006  HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY  Q5007  HOSPICE CARE PROVIDED IN LONG TERM CARE HOSPITAL (LTCH)  Q5008  HOSPICE CARE PROVIDED IN INPATIENT PSYCHIATRIC FACILITY  Q5009  HOSPICE CARE PROVIDED IN PLACE NOT OTHERWISE SPECIFIED (NOS)  Q5010  Hospice home care provided in a hospice facility
(Medicare Claims Processing Manual)
If care is rendered at multiple locations, each location is to be identified on the claim with a corresponding HCPCS code.  For example, routine home care may be provided for a portion of the billing period in the patients residence and another portion in an assisted living facility.  In this case, report one revenue code 651 line with HCPCS code Q5001 and the number of days of routine home care provided in the residence and another revenue code 651 line with HCPCS code Q5002 and the number of days of routine  home care provided in the assisted living facility.   Q5004 shall be used for hospice patients in a skilled nursing facility (SNF), or hospice patients in the SNF portion of a dually- certified nursing facility. There are 4 situations where this would occur:   1) If the beneficiary is receiving hospice care in a solely -certified SNF.  2) If the beneficiary is receiving general inpatient care in the SNF.  3) If the beneficiary is in a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness and related conditions, and is receiving hospice routine home care; this is uncommon. 4) If the beneficiary is receiving inpatient respite care in a SNF.   If a beneficiary is in a nursing facility but doesnt meet the criteria above for Q5004, the site shall be coded as Q5003, for a long term care nursing facility.  General inpatient care provided by hospice staff requires line item visit reporting in units of 15 minute increments when provided in the following sites of service:  Skilled Nursing Facility (Q5004), Inpatient Hospital (Q5005), Long Term Care Hospital (Q5007), Inpatient Psychiatric Facility (Q5008).  These service location HCPCS codes are not required on revenue code lines describing the visits provided under each level of care.   These lines report the HCPCS codes shown in the table under Revenue Codes.  Modifiers
(Medicare Claims Processing Manual)
The following modifier is required reporting for claims:  PM  Post -mortem visits.  Hospices shall report visits and length of visits (rounded to the nearest 15 minute increment), for nurses, aides, social workers, and therapists who are employed by the hospice, that occur on the date of death, after the patient has passed away.  Post mor tem visits occurring on a date subsequent to the date of death are not to be reported.  The reporting of post -mortem visits, on the date of death, should occur regardless of the patients level of care or site of service.  Date of  death is defined as the date of death reported on the death certificate.  Hospices shall report hospice visits that occur before death on a separate line from those which occur after death.   For example, assume that a nurse arrives at the home at 9 pm to provide routine home care (RHC) to a dying patient, and that the patient passes away at 11 pm.  The nurse stays with the family until 1:30 am.  The hospice should report a nursing visit with e ight 15-minute time units for the visit from 9 pm to 11 pm.  On a separate line, the hospice should report a nursing visit with a PM modifier with four 15- minute time units for the portion of the visit from 11 pm to midnight to account for the 1 hour post mortem visit.   If the patient passes away suddenly, and the hospice nurse does not arrive until after his death at 11:00 pm, and remains with the family until 1:30 am, then the hospice should report a line item nursing visit with a PM modifier and four 15- minute incremen ts of time as the units to account for the 1 hour post mortem visit from 11:00 pm to midnight.   The following modifier may be used to identify requests for an exception to the consequences of not filing the NOE timely:
(Medicare Claims Processing Manual)
The following modifier may be used to identify requests for an exception to the consequences of not filing the NOE timely:   KX -  Even if a hospice believes that exceptional circumstances beyond its control are the cause of its late -filed NOE, the hospice shall file the associated claim with occurrence span code 77 used to identify the non- covered, provider liable days.  The hospice shall also report a KX modifier with the Q HCPCS code reported on the earliest dated level of care line on the claim.  The KX modifier shall prompt the A/B MAC (HHH) to request the documentation supporting the request for an exception.  Based on that documentation, the A/B MAC (HHH) shall determine if a circumstance encountered by a hospice qualifies for an exception.  If the request for an exception is approved by the A/B MAC (HHH), the A/B MAC (HHH) shall process the claim with the CWF override code and remove the submitted provider liable days, which will allow payment for the days associated with the late -filed NOE.  If the A/B MAC (HHH) finds that the documentation does not support allowing an exceptional circumstance, the A/B MAC (HHH) shall process the claim as submitted.  The contractor shall use the following remittance advice messages and associated codes under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three  Group Code: CO  CARC: 96  RARC: MA54  MSN: N/A  Hospices may appeal the contractors determination that an exceptional circumstance did not apply. Modifier GV may be used to identify attending physician services performed by a doctor of medicine, doctor of osteopathy, nurse practitioner or physician assistant .  Service Date   The HIPAA standard 837 Institutional claim format requires line item dates of service for all outpatient claims.  Medicare classifies hospice claims as outpatient claims (see Chapter 1, 60.4).    Service date reporting requirements will vary between continuous home care lines (revenue code 652) and other revenue code lines.
(Medicare Claims Processing Manual)
Service date reporting requirements will vary between continuous home care lines (revenue code 652) and other revenue code lines.   Revenue code 652  report a separately dated line item for each day that continuous home care is provided, reporting the number of hours, or parts of hours rounded to 15-minute increments, of continuous home care that was provided on that date.  Other level of care revenue codes  report a separate line for each level of care provided at each service location type, as described in the instructions for HCPCS coding reported above.  Hospices report the earliest date that each level of care was provi ded at each service location.  Attending physician services should be individually dated, reporting the date that each HCPCS code billed was delivered.   Service reporting revenue codes  report dates as described in the table above under Revenue Codes.   For service visits that begin in one calendar day and span into the next calendar day, report one visit using the date the visit ended as the service date.   Service Units   The hospice enters  the number  of units  for each  type  of service.   Units  are measured  in days for revenue codes  651, 655, and  656. , Units for revenue code 652 are reported in 15-minute increments.   When days are non -covered due to not filing a timely NOE, the hospice reports two lines for the affected level of care.  For example, if a billing period contains 31 days of routine home care and the first 5 days are non -covered due to not filing a timely NOE:   The hospice reports one revenue code 0651 line containing the earliest non-covered date of service, 5 units and all non- covered charges   The hospice reports a second revenue code 0651 line containing the first covered date of service, 26 units and all covered charges.    Report units for service reporting lines as a multiplier of the visit time defined in the HCPCS description.   When the revenue code or HCPCS code requires 15 -minute increment reporting, visits of any length are to be reported, rounding the time to the nearest 15- minute increment.   For dates of service on and after 10/1/2018, units for summary drug charges lines may be reported using 1 to satisfy the required field or using a number of drugs provided during the billing period, at the option of the hospice.  Service unit data will n ot be used by Medicare for payment or data analysis.   Total Charges