Hospice-Billing-Code-Changes

REMINDER: Hospice Billing Code Changes Go Into Effect July 1st

HEALTHCAREfirst‘s Hospice Software to Assist Users.

Back in February, I posted information about upcoming Hospice Billing code changes. These changes are set to go into effect in just a few days, on July 1st. As a reminder to providers, 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.

HEALTHCAREfirst is implementing billing checks to assist providers with these changes.

Hospice claims will be returned if they 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).

Click here to view the full Change request

Click here to view the MLN Matters article

June 27, 2012
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