Hospice Regulation Changes: A 2014 Snapshot

Hospice Compliance Update.

With a plethora of new rules and regulations on the horizon, 2014 promises to be a very busy year for hospice providers, particularly for hospice staff responsible for regulatory compliance.  Here’s a quick snapshot of some of the major regulatory changes happening in 2014.

Additional Data Reporting on Hospice Claims – CMS Change Request 8358
Dates to Remember: Voluntary reporting begins January 1; mandatory reporting begins April 1

On July 26, 2013, CMS issued Change Request 8358 (CR 8358) detailing the additional information hospices will be required to report when submitting their claims for payment as authorized by Section 3132(a) of the Affordable Care Act.  Specifically, CR 8358 requires hospices to provide additional information regarding:

    • the location of care when billing for General Inpatient Care (GIP) level of care;
    • the NPI of any SNF, hospital or hospice IPU when the location of care is not the same location as the billing hospice’s location;
    • the use of a -PM modifier when visits occur after death and on the same date of death;
    • the use of injectable and non-injectable prescription drugs; and
    • the use of infusion pumps.

Conversion to the ANSI 5010 Claim Format / Revised CMS-1500 Form
Date to remember: April 1, 2014

HIPPA requires that the Department of Health and Human Services (HHS) adopt new standards for healthcare providers and other covered entities to use when conducting certain health care transactions electronically, including the processing of electronic claims.  For hospice providers who bill electronically, this change should go mostly unnoticed.

Sunset of HIQA and Complete Conversion to HETS
Date to remember: April 7, 2014

On April 7, 2014, CMS will completely sunset the use of Health Insurance Query Access (HIQA, part of the DDE system) and move to HIPPA Eligibility Transaction System (HETS) for the release of information related to beneficiary eligibility for services. CMS has indicated the HETS system will be able to provide information on previous hospice admissions similar to the current HIQA system before the sunset date.

Hospice Item Set (HIS)
Date to remember: July 1, 2014

As required by CMS 42 CFR Part 418 Hospice Wage Index and Payment Update published on August 7, 2013, hospices will be required to collect and report data related to seven quality measures. Hospices are required to report two HIS records for each patient – a HIS-Admission record upon admission and a HIS-Discharge upon discharge.

ICD-10 Conversion)
Date to remember: October 1, 2014

After several delays, all U.S. healthcare providers will be converting from ICD-9 to ICD-10 on October 1st. CMS has already announced a National Testing Week for March 3-7.

For information regarding HEALTHCAREfirst and our firstHOSPICE Web-based hospice agency management solution, contact us today or visit us online at www.healthcarefirst.com.