Hospice Claims Adjustments

National Government Services has received reports of two issues that are currently affecting payments of some hospice claims that have been adjusted.

Hospice End of Life SIA Payment

Hospice claims are being adjusted with the expectation of receiving the EOL SIA payment for eligible services that occurred the month prior and within seven days of the beneficiary’s date of death. Due to changes implemented in the FISS with the January release, the adjustments are not paying correctly. At this time, providers are being asked to use the following workaround: adjust the discharge claim with patient status code 40, 41, and 42 and post the DOD IND “Y” on the beneficiary header and then adjust the prior month’s bill to pay the add-on.

Hospice Claims Overpaying Routine Home Care Days

A minimal number of claims with RHC days overpaying at the high routine home care rate when the prior days used is greater than 60 days. At this time, hospice claims with TOB 817 and 81I are paying at a RHC high rate when the days used is greater than 60. As of 2/28/2020, this issue is being researched.

Posted 3/11/2020