Medicare addresses how to report charges
The Centers for Medicare & Medicaid Services (CMS) has posted a question and answer that is of interest to hospice providers.
- Question: Change Request (CR) No. 5567 provided instructions for the expanded claims data reporting requirements for Medicare hospice claims. As part of those instructions, in Section 30.3 "Data Required on Claim to FI" of Chapter 11 "Processing Hospice Claims" of the Medicare Claims Processing Manual, CMS states that as part of the reporting of visit information on the hospice claim, hospices are required to report "charges" for the services described on each revenue code line. Can CMS provide further guidance as of how to report "charges" on the hospice claim?
- Answer: With regard to guidance to hospices on how to report charges on the hospice claim, we refer hospices to these areas of CMS' manuals:
1. At Pub 100-04, CMS' Medicare Claims Processing Manual, Chapter 25, "Completing and Processing the Form CMS-1450 Data Set," we provide the following guidance/ instructions:
- Under Section 75.5 Form Locators 43-81, for "FL 47 Total Charges," we say the following: This is the FL in which the provider sums the total charges for the billing period for each revenue code (FL 42); or, if the services require, in addition to the revenue center code, a HCPCS procedure code, where the provider sums the total charges for the billing period for each HCPCS code. The last revenue code entered in FL 42 is "0001," which represents the grand total of all charges billed. The amount for this code, as for all others, is entered in FL 47. Each line for FL 47 allows up to nine numeric digits (0000000.00). The CMS policy is for providers to bill Medicare on the same basis that they bill other payers. This policy provides consistency of bill data with the cost report so that bill data may be used to substantiate the cost report.
2. Furthermore, in CMS' Provider Reimbursement Manual, Part 1, Chapter 22, "Determination of Costs of Services," we say at:
- Section 2203, "Provider Charge Structure as Basis for Apportionment," that to ensure that Medicare's share of the provider's costs equitably reflects the costs of services received by Medicare beneficiaries, the intermediary, in determining reasonable cost reimbursement, evaluates the charging practice of the provider to ascertain whether it results in an equitable basis for apportioning costs. So that its charges may be allowable for use in apportioning costs under the program, each facility should have an established charge structure that is applied uniformly to each patient as services are furnished to the patient and which is reasonably and consistently related to the cost of providing the services. While the Medicare program cannot dictate to a provider what its charges or charge structure may be, the program may determine whether or not the charges are allowable for use in apportioning costs under the program.
- Section 2204, "Medicare Charges," we further say that the Medicare charge for a specific service must be the same as the charge made to non-Medicare patients (including Medicaid, CHAMPUS, private, etc.), must be recorded in the respective income accounts of the facility, and must be related to the cost of the service. (See §2202.4.)
- Section 2202, "Definitions," at 2202.4 "Charges," we say that charges refer to the regular rates established by the provider for services rendered to beneficiaries and to other paying patients. Charges should be related consistently to the cost of the services and uniformly applied to all patients whether inpatient or outpatient. All patients' charges used in the development of apportionment ratios should be recorded at the gross value; i.e., charges before the application of allowances and discounts deductions. (See §2206.l for information on accrual of charges and §2204.l for hospital-based physician charges.)
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