E-mail Page
Print- Home
- Part A
Medicare Part A Links
- Claims Processing Issues
- Rates and Fee Schedules
- Deductibles and Coinsurance
- Taxonomy Codes
- Medicare Secondary Payer
- About Provider Enrollment
- Check Status of Current Application
- CMS-855A Packet
- Enrollment Forms
- Electronic Funds Transfer
- Provider-Based Status Determinations
- LCDs and Articles
- LCD Comment and Reconsideration Process
- National Coverage Determinations
- Investigational Devices
- Medical Review
- Signature Guidelines
- Part B
Medicare B Links
- HH + H
Home Health + Hospice Links
- Redetermination
- Reconsideration
- Administrative Law Judge Hearing
- Appeals Council Review
- Final Judicial Review
- Forms
- Active LCDs
- Draft LCDs
- Retired LCDs
- Reconsideration Process
- Home Health Coverage Guidelines
- Hospice Coverage Guidelines
- National Coverage Determinations
- Progressive Corrective Action
- PrePayment Review
- Postpaymet Review
- Additional Development Request
- Comparative Billing Reports
- Denial Reason Codes
- Forms
- FAQ
- Contact Us
Hospice Change Request 6440 Q&As
General
What are the major changes to hospice billing associated with this CR?
To summarize this CR, hospice providers are required to line item bill all visits, including skilled nursing, aide, and social worker for claims with dates of service January 1, 2010, and after. In addition, this CR now requires hospices to line item bill therapies, including physical, occupational and speech language pathology. Lastly, hospices are now required to report social worker phone calls that are necessary for the palliation and management of the terminal illness and related conditions, as described in the plan of care . Visits and phone calls that must be reported according to CR 6440 must be billed in 15-minute increments.
Updated 03/2010 (CMS FAQ 9970)
15-Minute Increments
How do I determine how many 15-minute increments to submit on my claim?
All visits up to 15 minutes in length are reported as one unit. For example, a 5-minute visit is billed as 1 unit. Visits longer than 15 minutes are rounded to the nearest 15-minute increment, using general mathematical rounding principles. A 20-minute visit would be rounded down, and submitted as 1 unit. A 25-minute visit would be rounded up, and submitted as 2 units. These same rules apply when reporting social worker phone calls.
When counting the 15-minute increments for visits, do I include documentation time?
Documentation time (such as the updating of medical records), which occurs during, and as part of an otherwise covered and billable visit to a patient, can be included in the time reported for the visit. Documentation time, which occurs outside the context of such a visit, is not reportable.
Visits under Respite or GIP
Are hospices required to report discipline visits (skilled nurse, aide, social worker, PT, SLP, and OT) when a patient is under general inpatient care (GIP)?
Change Request 6440 does not change any reporting requirements for services provided to beneficiaries under GIP. If the beneficiary is in a contracted GIP facility, visits provided by contracted staff do not need to be reported. If hospice staff provides visits to the beneficiary while in the contracted facility under GIP, the visits are reported on one revenue code line, with the units reflective of the number of visits provided in the week (Sun-Sat) while in GIP at the facility.
Are hospices required to report discipline visits (skilled nurse, aide, social worker, PT, SLP, and OT) when a patient is under respite?
Yes, CR 6440 does apply to visits provided under respite. All visits provided by hospice staff to a patient under respite, must be reported. In addition, if the respite facility is hospice-owned, all visits under respite must be reported. However, if the hospice patient is receiving respite care in a contract facility, visits by non-hospice staff should not be reported.
Social Worker Phone Calls
When are social worker phone calls reported on the claim?
CMS has clarified this with FAQ
#9970 posted on their Web site, www.cms.gov.
Updated 03/2010
What if the phone call is made during a social worker visit?
Phone calls made on behalf of a patient during the course of a visit with the patient or his family should not be reported on hospice claims.
Billing under CR 6440
What are the revenue and HCPCS codes required under CR 6440?
CR 6440 requires hospice to report physical therapy visits with revenue code 042X, occupational therapy visits with 043X, and speech language pathology visits with 044X. In addition, a HCPCS code is now required on all discipline lines. The table below defines all of the discipline revenue codes and their associated HCPCS. Claims submitted without a HCPCS code on the discipline revenue code lines will be returned to the provider (RTP).
| Discipline | Revenue Code | HCPCS Code |
|---|---|---|
| Physical Therapy | 042X | G0151 |
| Occupational Therapy | 043X | G0152 |
| Speech Language Pathology | 044X | G0153 |
| Nursing | 055X | G0154 |
| Medical Social Services | 056X | G0155 |
| Social Worker Phone calls | 0569 | G0155 |
| Aide | 057X | G0156 |
NOTE: The “X” denotes a place holder. Do
not submit your claim with an “X”. Hospices should follow
NUBC coding guidelines for the use of the appropriate fourth position
(the “X”) when reporting these revenue codes. For
more information, refer to the Medicare
Claims Processing Manual (Pub. 100-04) Ch. 25, section 75.4.
When can I start submitting the new data on my hospice claims?
Hospices can optionally submit the new data for claims with dates of service October 1, 2009. The new data will be required for claims with dates of services January 1, 2010, and after.
What will happen to my claim if it is submitted without the new HCPCS codes for disciplines?
Effective January 1, 2010, the claim will be returned to the provider (RTP) for correction with reason code 31428 or 31429. The appropriate HCPCS code must be added to the claim in RTP and resubmitted to resume processing.
How are units billed under CR 6440?
For discipline visits (SN, MSW, aide, PT, SLP, and OT), the units reflect the intensity of the visit, in 15-minute increments (15 minutes = 1 unit, 30 minutes = 2 units, etc.). All visits up to 15 minutes in length are reported as one unit. Visits longer than 15 minutes are rounded to the nearest 15-minute increment (up or down), using general mathematical rounding principles. These same rules apply to social worker phone calls. There is no change to how units for the levels of care are billed; these still reflect the number of days provided at routine, respite or GIP, and the number of 15-minute increments for continuous home care.
How many revenue code lines are available in the Fiscal Intermediary Standard System?
FISS Page 02 holds up to 14 revenue code lines per revenue code page, and there are 32 revenue code pages available. To access a new revenue code page, from FISS Page 02, press your F6 button to page forward to the next revenue code page. In total, FISS has space available for up to 450 revenue code lines. For more information, refer to the Claims and Attachments Menu section of the FISS Reference Guide.
How should the charges for the disciplines be entered since there is no separate Medicare payment for them?
Charges for the discipline revenue code lines (042X, 043X, 044X, 055X, 056X, 057X) should be entered as covered charges (TOT CHARGE field in FISS). The charges should not be entered as noncovered (NCOV CHARGE). The charges on the discipline revenue code lines will process as covered, but no additional reimbursement will be generated. Remittance advice (RAs/ERAs) will contact the ANSI group code “CO” and an adjustment reason code ‘97’ for these charges. In addition, the beneficiary’s Medicare Summary Notice (MSN) will show the charges as covered.
What is considered “a visit”? When should “a visit” be recorded on the claim?
The definition of “a visit” has not changed from what was true with Change Request 5567. To be counted, the visit must be reasonable and medically necessary for the palliation and management of the patient’s terminal illness and related conditions as described in the plan of care.
How are multiple visits made in the same day billed?
Each visit must be billed on a separate revenue code line. Therefore, if two nursing visits were provided in the same day, you must bill two revenue code lines; one for each visit.
Page last updated: March 19, 2010
