Revision to Processing Hospice Visit Charges on Remittance Advices and Medicare Summary Notices (MSNs)
MLN Matters® Number: MM6386
Related Change Request (CR) #: 6386
Related CR Release Date: April 24, 2009
Effective Date: October 1, 2009
Related CR Transmittal #: R471OTN
Implementation Date: October 5, 2009
Provider Types Affected
Hospice providers submitting claims to Medicare Fiscal Intermediaries (FIs) and Regional Home Health Intermediaries (RHHIs) for hospice services provided to Medicare beneficiaries.
Provider Action Needed
This article is based on Change Request (CR) 6386. The Centers for Medicare & Medicaid Services (CMS) wants providers to know that hospice visit charges that are covered in the hospice bundled payment are showing on the MSN as non-covered and causing confusion and unnecessary appeals by beneficiaries. Upon implementation of CR 6386, CMS will show these charges as covered on the remittance advice and MSN in order to reduce confusion, improper payments by some secondary payers and unnecessary appeals by beneficiaries.
Background
MLN Matters article MM5567 entitled “Reporting of Additional Data to Describe Services on Hospice Claims” discussed the requirement for hospice providers to report the number of nursing, aides and social worker visits on the claim. MM5567 may be reviewed at www.cms.hhs.gov/MLNMattersArticles/downloads/mm5567.pdf on the CMS Web site. The charges associated with those visits are currently being processed as non-covered by Medicare systems with the remittance advice code 97 “Payment adjusted because the benefit for this service is included in the payment / allowance for another service / procedure that has already been adjudicated.” The remittance codes are sent to supplemental payers; however, the presence of these charges appearing as non-covered on the remittance advice notice may have caused some secondary payers to make inappropriate payment for these visits.
In addition, there has also been some confusion regarding these charges appearing as non-covered on the beneficiary Medicare Summary Notice (MSN) resulting in some beneficiaries requesting an appeal of the non-covered charges, although these charges are not reflected on the MSN in the “You May Be Billed” column. There is no beneficiary liability for these charges and therefore, no appeal is necessary.
Charges associated with the reported visits are covered under the hospice bundled payment and reflected in the payment for the level of care billed on the claim. No separate or additional payment is made for the charges reported on the revenue lines reflecting visits. However, to minimize confusion for these charges Medicare will change the outcome of processing these charges to reflect as covered on the remittance advice notice and the MSN. In addition, the MSN sent to the beneficiary will reflect the following message “You should not be billed for this service. You are only responsible for any deductible and coinsurance amounts listed in the ‘You May Be Billed’ column”.
Additional Information
If you have any questions, please contact our provider service center at our toll-free number, (866) 801-5301.
The official instruction, CR6386, issued to your Medicare RHHI or FI regarding this change may be viewed at www.cms.hhs.gov/Transmittals/downloads/R471OTN.pdf on the CMS Web site.
Disclaimer: This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
Note: In the content of this article, the following links open a PDF document:
www.cms.hhs.gov/MLNMattersArticles/downloads/mm5567.pdf (PDF, 89 KB
www.cms.hhs.gov/Transmittals/downloads/R471OTN.pdf (PDF, 123 KB)