The Centers for Medicare & Medicaid Services (CMS) issued a memorandum to all Part D sponsors and is available on the spotlight section of the hospice center web page at: http://www.cms.gov/Center/
Spotlights
- Clarification of Recovery of Part D Payment for Pain Medications for Beneficiaries Enrolled in Hospice
In our 1983 Hospice Care final rule and reiterated in the FY 2014 Hospice Wage Index and Payment rate update final rule CMS described it’s expectation that hospices are required to provide virtually all the care that is needed for terminally ill patients. Therefore, unless there is clear evidence that a condition is unrelated to the terminal prognosis; all services are to be considered related. In extremely rare instances where the hospice physician determines that a condition is unrelated to the terminal prognosis, it is the responsibility of the hospice physician to document why the patient’s medical needs would be unrelated to the terminal prognosis.
CMS issued a memorandum on October 30, 2013 entitled “Clarification of Recovery of Part D Payment for Pain Medications for Beneficiaries Enrolled in Hospice.” This memorandum provides additional guidance for Part D sponsors on the recovery of payment for drugs. The guidance augments the prior CPI guidance by outlining a consistent approach to financial reimbursement requests by Part D sponsors to hospice providers. - The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8416, entitled "Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, Quality Reporting Program and the Hospice Pricer for FY 2014," which is effective October 1, 2013.
- The Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare hospice wage index and Medicare hospice payment rates for fiscal year (FY) 2014. This final rule also provides clarification on diagnosis reporting on hospice claims, finalizes changes in the requirements for the hospice quality reporting program, and provides updates on hospice payment reform. Hospices serving Medicare beneficiaries will see an estimated 1.0 percent increase in their payments for FY 2014. The hospice payment increase is the net result of an estimated 1.7 percent increase in the “hospital market basket” update, which is offset by a 0.7 percent decrease in payments to hospices due to updated wage index data and the fifth year of CMS’ 7-year phase-out of its wage index budget neutrality adjustment factor (BNAF).
- On Friday July 26th, CMS issued CR 8358, entitled “Additional Data Reporting Requirements for Hospice Claims,” which will be effective for voluntary reporting as of January 1, 2014, and for required reporting as of April 1, 2014. This CR requires additional claims data reporting for hospices to support hospice payment form as authorized by the Affordable Care Act of 2010, section 3132(a).
- On June 1, 2012, CMS issued CR 7838, entitled “Updates to Caps and Limitations on Hospice Payment”, which moved the cap section of the hospice claims processing manual (IOM 100-04, chapter 11, section 80) to the hospice benefit policy manual (IOM 100-02, chapter 9, new section 90). CR 7838 also updated the aggregate cap policy to reflect the changes in cap policy which were finalized in the August 4, 2011 Hospice Wage Index Final Rule.
- The Centers for Medicare & Medicaid Services (CMS) recently issued Change Request (CR) 7675 entitled "Revisions to the Hospice Medicare Summary Notice (MSN)" and CR 7677 entitled "New Hospice Condition Code for Out of Service Area Discharges". Both CRs will be effective July 1, 2012.
- Correction to CMS-1355-NR [PDF, 183KB] (Text Version), "Hospice Wage Index for Fiscal Year 2012", which was published in the Federal Register on May 9, 2011: This Notice of Ruling was corrected to show the correct title, "Hospice Appeals for Review of an Overpayment Determination." Additionally, this Notice of Ruling was corrected change the effective date of this Notice of Ruling from "April 14, 2011" to "May 9, 2011". (Posted July 22, 2011)
- CMS-1355-R / CMS-1355-NR: Ruling (Issue Date: April 14, 2011; Publication Date: May 9, 2011). CMS issued a Ruling, effective April 14, 2011, establishing CMS policy related to when a hospice challenges the validity of the beneficiary counting methodology in its appeal of an overpayment determination for any hospice cap year ending on or before October 31, 2011. (Posted May, 6 2011)
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Important Links
Regulations and Related Transmittals
Billing & Payment Information
- Electronic Data Interchange (EDI) (Billing) - Medicare information on electronic transactions under HIPAA
- Hospice Aggregate Cap Amount for 2011
- Hospice Aggregate Cap Amount for 2009
- Hospice Aggregate Cap for 2008
Wage Index Files
- FY 2014 Wage Index [ZIP, 261KB]
- FY 2013 Wage Index [ZIP, 468KB]
- FY 2012 Final Wage Index [ZIP, 33KB]
- FY 2011 Final Wage Index [ZIP, 33KB]
- FY 2010 Wage Index [ZIP, 32KB]
- FY 2009 Wage Index [PDF, 249KB]
Managed Care Information
Medicare Hospice Data
- Medicare Hospice Data
- Hospice Data 1998-2009 [ZIP, 217KB]
- Hospice Data 1998-2008 [ZIP, 122KB]
- Standard Analytical Files
Medicaid Information
- FY 2014 Medicaid Hospice Payment Rates
- FY 2013 Medicaid Hospice Payment Rates [PDF, 91KB]
- FY 2012 Medicaid Hospice Payment Rates [PDF, 88KB]
- FY 2011 Medicaid Hospice Payment Rates [PDF, 109KB]
- Revised FY 2010 Medicaid Hospice Payment Rates [PDF, 95KB]
- State Medicaid Manual ; (See Section 4305 - Hospice Services)
Enrollment, Participation, & Certification
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Hospice Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- Hospice Survey & Certification - Certification & Compliance
- Hospice Survey & Certification - Guidance to Laws & Regulations
- CMS-417: "Hospice Request for Certification in the Medicare Program" Form
- Survey & Certification Policy & Memos to States and Regions
Educational Resources
- MLN General Information
- MLN Educational Web Guides
- MLN Matters Articles ( Search Tips )
- MLN Products
- MM5117 [PDF, 97KB] - Special Issues Associated with the Advance BEneficiary Notice (ABN) for Hospice Providers and Comprehensive Outpatient Rehabilitation Facilities (CORFs)
Beneficiary Notices Initiative
- Beneficiary Notices Initiative (BNI) - Use Advanced Beneficiary Notice (FFS ABN-G)
- FFS ED Notices
Uninsured Information
Research and Analyses
Hospice Face-to-Face
- Hospice Face-to-Face Guidance PowerPoint [PDF, 232KB]
- Update on Physician Signature Requirement and Face-to-Face Encounter Requirements [PDF, 37KB]
- Hospice Face-to-Face encounter FAQs - Opens in a new window
Quality Initiatives
- Hospice Quality Reporting
- Hospice Assessment Intervention and Measurement (AIM) Project - Opens in a new window
Other Important Hospice Information
Demonstration
- Rural Hospice Demonstration
- Active Projects Report - Evaluation of Rural Hospice Demonstration
Coding
- HCPCS - General Information
- HCPCS Release & Code Sets
- ICD-9-CM
- ICD-10
- Claim Adjustment Reason and Remittance Advice Remark Codes - Opens in a new window
National Provider Identifier (NPI)
CMS Manuals & Transmittals
- Manuals
- Internet-Only Manuals (IOMs)
- Transmittals
- To receive changes to the/ CMS Quarterly Provider Update, subscribe to the CMS Quarterly Provider Updates list.
- Medicare Benefit Policy Manual; Chapter 9 - Coverage of Hospice Services Under Hospital Insurance [PDF, 415KB]
- Medicare Claims Processing Manual; Chapter 11 - Processing Hospice Claims [PDF, 278KB]
- State Medicaid Manual ; (See Section 4305 - Hospice Services) Medicare General Information, Eligibility, and Entitlement Manual; Chapter 4 - Physician Certification and Recertification of Services [PDF, 104KB] - (See Section 60 - Certification and Recertification by Physicians for Hospice Care)
- Provider Reimbursement Manual - Part II
- National Coverage Determinations (NCD) Manual - Pub. 100-03
Medicare Secondary Payer
Fraud & Abuse
How to Stay Informed
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Home Health, Hospice & Durable Medical Equipment Open Door Forum
- Questions and Answers: Hospice
- Media Release Database: Press Releases
General Provider Information - Coverage
- Medicare Coverage - General Information
- Medicare Coverage Database - Opens in a new window
- National Coverage Determinations (NCD) Manual - Pub. 100-03
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