Updates on Hospice Payment Reform.
Last week the Centers for Medicare and Medicaid Services (CMS) issued a notice to update the Medicare Hospice Wage Index for fiscal year (FY) 2013. The notice also provided clarification on additional diagnoses reporting on hospice claims and updates on hospice payment reform and hospice quality reporting. The FY 2013 hospice payment rates are effective for care and services furnished on or after October 1, 2012 through September 30, 2013.
- Payment Reform – Hospices serving Medicare beneficiaries will see an estimated 0.9% increase in their payments for FY 2013. The hospice payment increase is the net result of a 1.6% increase in the “hospital market basket” update, which is offset by a 0.7% decrease in payments to hospices due to updated wage index data and the fourth year of CMS’ 7-year phase-out of its wage index budget neutrality adjustment factor (BNAF).
|Code||Description||Rate||Wage Component Subject To Index||Non-Weighted Amount|
|0651||Routine Home Care||$153.45||$105.44||$48.01|
|0652||Continuous Home Care|
Full Rate = 24 hrs of care
$ = 37.32 hourly rate
|0655||Inpatient Respite Care||$158.72||$85.92||$72.80|
|0656||General Inpatient Care||$682.59||$436.93||$245.66|
- Hospice Cap – The hospice cap amount for the cap year ending October 31, 2012 is $25,377.01.
- Additional diagnoses reporting – CMS reported in the notice that recent analyses showed 77.2% of hospice claims from 2010 reported only a single diagnosis. CMS believes that most Medicare patients at the end-of-life are elderly and likely have multiple comorbidities. Claims that only report a principal diagnosis are not providing an accurate description of the patients’ conditions. To account for any clinical complexities a given patient might have as a result of related comorbidities, the comorbidities related to the terminal illness must be included on the Medicare hospice claim.
- Hospice quality reporting – Hospices are required to begin collecting quality data in October 2012, and will submit that quality data in 2013. Hospices failing to report quality data in 2013 will have their market basket update reduced by 2 percentage points in FY 2014. CMS noted that these requirements are not changing. CMS did propose quality data reporting requirements for FY 2015 and thereafter, however they were included in the HH PPS Rate Update for Calendar Year 2013 proposed rule.
To access the full change request click here.
To access the full notice (CMS-1434-N) click here.