Hospice Conferences: Line Item Visit Billing Requirements

By Author: Angela Martin
Total Articles: 206
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Till date, this year has been a busy one for new claim requirements, and the change requests are not over as yet. From itemizing visits to tracking social work phone calls and line item billing for levels of care, if you are not reporting the details correctly, you could be risking denials.


Itemize visits per day in billing: This year began with change request 6440 which was effective for service dates post January 1. This new claim requirement altered the way hospice visits are reported, requiring line item billing of visits for all service disciplines in 15-minute increments, rather than on a weekly basis.


On a particular day, each visit must now be listed individually. To add to it, you must now bill for therapy services carried out by direct staff and contract staff addressing the terminal illness.


The change applies to visits provided by hospice employees to patients getting routine home care, continuous home care or respite care.


C.R. 6440 also needs that you report medical social services phone calls for providing care to or coordination care ...
... of a patient for the palliation & management of the terminal illness and related conditions.


Confusing: This requirement could result in situations where three calls take place in a span of 20 minutes and you must bill for each call separately, even though they lasted less than 15 minutes.


For claims and notices of election with dates of service (DOS) on or after April 1, CR request 6540 requires that you report two doctors. This new requirement means you must report both the attending doctor and the hospice doctor certifying the terminal illness.


And this requirement holds true even if the attending doctor and hospice doctor is the same individual. In that case, you would list the same doctor's name in both required claim fields.


You should be providing line item reporting of hospice levels of care for claims got on or post April 29 this year, as per requirements in change request 6791.


Now, for routine home care (RHC), respite care and general inpatient care (GIP), new claim services dates and lines must be reported each time a level of care changes. Service units need to report consecutive number of days at that level of care and the service date must report the first date at that level of care.


Remember: The effective date of this requirement is not based on date of service, however on when the claim was received by Medicare. For more on this, sign up for hospice conferences (audio conferences).