0221- Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements

Dynamic List Information
Dynamic List Data
Issue Name
0221- Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements
Review Type
Complex
Provider Type
Hospice
MAC Jurisdiction
HH/Hospice MACs
Date
2023-10-05
RAC Type
Approved

Description

This review will determine if billed Hospice Care with Extended Lengths of Stay was reasonable and necessary. Claims that do not meet the indications of coverage and/or medical necessity will be denied and result in an overpayment.

Affected Code(s)

•    0651- Routine Home Care
•    0652- Continuous Home Care
•    0655- Inpatient Respite Care

Applicable Policy References

1.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §§1812(a)(4), (a)(5), and (d)- Scope of Benefits.
2.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1813(a)(4)(A)- Deductibles and Coinsurance.
3.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1814(a)(7)- Conditions of and Limitations on Payment for Services.
4.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1814(i)(1)(A)- Payment for Hospice Care.
5.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §§1815(a) and (e)(2)(D)- Payment to Providers of Services.
6.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1833(e)- Payment of Benefits.
7.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §§1861(u)- Provider of Services and (dd)- Hospice Care; Hospice Program.
8.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1862(a)(1)(A), (a)(1)(C), (a)(6), and (a)(9)- Exclusions from Coverage and Medicare as Secondary Payer
9.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1879 (g)(2)- Limitation of Liability of Beneficiary Where Medicare Claims are Disallowed.
10.    42 CFR §405.929- Post-Payment Review.
11.    42 CFR §405.930- Failure to Respond to Additional Documentation Request.
12.    42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
13.    42 CFR §405.986 - Federal Health Insurance for The Aged and Disabled, Good Cause for Reopening.
14.    42 CFR, §411.15(k)(2) - Exclusions from Medicare and Limitations On Medicare Payment, Particular Services Excluded from Coverage.
15.    42 CFR §418– Hospice Care.
16.    Medicare General Information, Eligibility, and Entitlement Manual, Chapter 1, §10- General program Benefits, §10.1- Hospital Insurance (Part A) for Inpatient Hospital, Hospice, Home Health and Skilled Nursing Facility (SNF) Services - A Brief Description.
17.    Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, §60- Certification and Recertification by Physicians for Hospice Care.
18.    Medicare General Information, Eligibility and Entitlement Manual, Chapter 5, §60 - Hospice Defined.
19.    Medicare Benefit Policy Manual, Chapter 9, §§10- Requirements—General; 20- Certification and Election Requirements; 30.2- Respite Care Coinsurance; 40- Benefit Coverage; 50- Limitation on Liability for Certain Hospice Coverage Denials ; 80- Hospice Pre-election evaluation and counseling services; 90- Caps and Limitations on Hospice Payments.
20.    Medicare Claims Processing Manual Chapter 11, §30- Billing and Payment for General Hospice Services.
21.    Medicare Claims Processing Manual Chapter 11, §100- Billing for Hospice Denials
22.    Medicare Claims Processing Manual, Chapter 30, §50- Advance Beneficiary Notice of Non-coverage (ABN).
23.    Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6 
24.    CGS Administrators, LLC, LCD L34538- Hospice Determining Terminal Status; Effective 10/01/2015; Revised 07/06/2023.
25.    National Government Services, Inc., LCD L33393 Hospice Determining Terminal Status; Effective 10/01/2015; Revised 11/14/2019.
26.    National Government Services, Inc., LCA A52830 Billing and coding: Hospice: Determining Terminal Status; Effective 10/01/2015; Revised 11/14/2019
27.    CMS, Hospice: CMS Flexibilities to Fight Covid-19, Revised 05/10/2023. Hospice: CMS Flexibilities to Fight COVID-19