Visit data and charges required for payment
Set charges carefully, ensure accurate data
The month of June saw many hospice managers scrambling to develop data collection processes and test software to make sure that claims filed after the July 1, 2008, implementation date for the new Medicare hospice billing rule would be paid.
"Data collection is the biggest issue for most hospices," says Pat Laff, managing principal of Laff Associates, a Hilton Head Island, SC-based homecare consulting firm. Hospices that do not use point-of-care technology must have manual systems to collect visit data to submit with claims, he explains. Daily activity logs that indicate if the visit is reportable can be used by anyone, he says.
"If a hospice is using point-of-care technology, there is a method to capture the data, but the hospice managers must work with the software vendors to make sure the data is collected," Laff says. Once again, the clinicians will need to know how to code reportable visits to ensure accurate claims, he adds.
Test your system
Even with a point-of-care system, testing is critical, points out Marion F. Keenan, president of Coastal Hospice in Salisbury, MD. Keenan's hospice uses Misys Homecare (Misys Healthcare Systems, Raleigh, NC). "Our system automatically puts all of our visits into the system as clinicians make their visits," she says. "We did decide in early June to upgrade our software to a newer version to make sure we capture the best data, and we tested the system," she says.
Reportable visits are any hands-on care visits, explains Laff. The billing rule requires that hospices collect and report the number of visits for RNs, LVNs, aides, social workers, physicians, and nursing practitioners on each bill, he points out. "Delivering supplies is not reportable," Laff says. In addition to the numbers of visits, a charge for each visit reported must be included, he adds.
The National Association of Home Care (NAHC) has developed templates and work sheets to help hospices develop a charge per visit, says Laff. Direct and indirect costs should be included, Laff points out. "Make sure that your charges are greater than your costs," he adds.
Coastal Hospice has had a per-visit rate for many years, says Keenan. Although a per-visit rate is not common in hospice, the hospice developed and used per-visit rates due to private insurers requirements. "We periodically review and update our rates to make sure they reflect our costs," she adds.
When setting per-visit charges, be sure to document how you arrived at your charge, suggests Keenan. "Make sure you can show your rationale for the charges and have a record of what is included and how you made the decision," she adds. Although collecting data and assigning per visit charges is unfamiliar to hospice managers, the information will give managers another way to evaluate the financial performance of their organization, Keenan points out.
Data collection for visits and charges, along with data collection for quality improvement studies required by the new Conditions of Participation, are just the first step to other changes, predicts Laff. "I believe that we're looking at a possible change in the way hospice is paid, and we'll move away from a per diem rate," he says.
Need More Information?
For more information about the hospice billing rule, contact:
- Pat Laff, Managing Principal, Laff Associates, 117 Club Course Drive, Hilton Head Island, SC 29928. Telephone: (843) 671-4170. Fax: (843) 671-4306. E-mail: [email protected].
- For hospice charge template, go to the National Association of Home Care web site: www.nahc.com. Select "Facts and Stats" from top navigational bar, then scroll down to "Hospice Charges Worksheets."
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