Effective in September 2009, all hospice providers submitting claims to Palmetto GBA will receive their individual Non-Cancer Length of Stay (NCLOS) Rate information including the all categories NCLOS rate through the US Mail within six to 12 weeks after the closure of the measurement period. This precludes the need to submit a written request for this information, as previously required. The anticipated date of receipt of letters to providers for the fist six months of data for 2009 is late September 2009.
NCLOS Rates1 permit Palmetto GBA to characterize its entire hospice provider population using at least six months of claims data. This approach allows Palmetto GBA to document variations in the proportion of long-stay non-cancer patients (>210 days) at the regional, state and provider levels. While these quantitative data do not necessarily reflect the appropriate or inappropriate provision of hospice services under Medicare, they do allow for the identification of trends and possible educational opportunities.
Palmetto GBA’s Regional Home Health and Hospice Intermediary (RHHI) includes 16 states. These 16 states may be divided geographically into four sub-regions: Southeast (Kentucky, North Carolina, South Carolina and Tennessee), Southwest (Arkansas, Louisiana, New Mexico, Oklahoma and Texas), Gulf Coast (Alabama, Florida, Georgia and Mississippi) and Midwest (Illinois, Indiana and Ohio).
The data used to calculate the NCLOS Rates reported below were obtained from non-cancer claims paid during the period January 1, 2009, to June 30, 2009, and subject to Palmetto GBA’s Hospice Local Coverage Determinations (LCDs).
The NCLOS Rates table below summarizes the experience of hospice providers submitting non-cancer claims to Palmetto GBA for all nine non-cancer diagnosis categories by region. The accompanying PDF files describe the policy specific NCLOS rate data by region and also the provider-specific NCLOS Rates by state and by policy. To view these files, select the PDF documents below.
Any questions regarding the NCLOS rates may be directed to A.Policy@PalmettoGBA.com or to:
Part A Medical Affairs
Palmetto GBA - Mail Code: AG-300
P.O. Box 100238
Columbia, SC 29202-3238
In your communication, please include the following information:
1. Contact Name
2. Telephone number and extension (if applicable)
3. Provider Number
NCLOS Rates
|
Diagnosis Category
|
Southeast
|
Southwest
|
Gulf Coast
|
Midwest
|
All Regions
|
|
ALS
|
0.21
|
0.28
|
0.25
|
0.22
|
0.24
|
|
The Adult Failure to Thrive Syndrome
|
0.22
|
0.27
|
0.25
|
0.2
|
0.24
|
|
Alzheimer's Disease & Related Disorders
|
0.28
|
0.34
|
0.31
|
0.29
|
0.31
|
|
Heart Disease
|
0.2
|
0.23
|
0.23
|
0.16
|
0.21
|
|
HIV Disease
|
0.10
|
0.13
|
0.14
|
0.10
|
0.12
|
|
Liver Disease
|
0.08
|
0.08
|
0.09
|
0.08
|
0.08
|
|
Pulmonary Disease
|
0.2
|
0.22
|
0.21
|
0.15
|
0.19
|
|
Renal Disease
|
0.06
|
0.06
|
0.05
|
0.04
|
0.05
|
|
Stroke & Coma
|
0.15
|
0.19
|
0.15
|
0.10
|
0.15
|
|
All Categories
|
0.2
|
0.24
|
0.22
|
0.17
|
0.21
|
1NCLOS Rate values may range from zero with no beneficiaries had lengths of stays greater than 210 days, to one all had stays greater than 210 days. The units are per 100 beneficiaries (e.g., a NCLOS Rate of 0.15 means that 15 beneficiaries out of 100 had stays greater than 210 days)