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NEWSFLASH: Hospice Billing Changes Coming in July 2012

Hospice Code Updates.

Starting in July, hospices will be required to discontinue use of occurrence code 42 when a provider initiates the termination of hospice care and for hospices to only use occurrence code 42 to indicate a discharge due to a patient revocation. Hospices must also begin to use the new condition code to indicate a discharge due to the patient’s unavailability/inability to receive hospice services from the hospice which has been responsible for the patient.

Medicare will begin returning hospice claims that meet the following criteria with dates of service on or after July 1, 2012:

  • Both condition code 52 and condition code H2 are present;
  • Condition code 52 is present and the patient status code is 30;
  • Condition code H2 is present and the patient status code is 30;
  • Condition code H2 is present with occurrence code 42; or
  • Condition code 52 is present with occurrence code 42.

Additionally the following revenue code and reason code changes apply to claims submitted on or after July 1, 2012:

  • Medicare will pay revenue code 0657 when reported with a GV modifier appended to the HCPCS code at the lower of the submitted charge or 85% of the Medicare Physician Fee Schedule.
  • Medicare will adjust hospice claims already processed containing revenue code 0657 reported with a GV modifier appended to a HCPCS code if payment was made at 85% of the submitted charges and the claim is brought to the attention of your Medicare contractor within 6 months of the implementation date of CR7677, which is July 2, 2012.
  • When Medicare contractors deny hospice room and board charges, they will use claim adjustment reason code 96 for non-covered service and group code PR (Patient responsibility).

HEALTHCAREfirst will post a reminder in June for recipients of the blog and will send providers using HEALTHCAREfirst software information about billing checks implemented to assist with these changes.

Click here to view the full Change request
Click here to view the MLN Matters article

February 3, 2012
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