Hospice / home health
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Spotlight
Hospice: New requirement for physicians who certify patient eligibility
Physicians who certify patient eligibility for hospice services must enroll in Medicare or opt out effective for claims submitted on October 7 and after with dates of service June 3 or later.
View CMS Newsroom Center (Spotlights, news, media releases, outreach, mailing lists, etc.)
CMS Quarterly Provider Updates (QPU)
LCD / NCD policy information
First Coast, as the jurisdiction N Part A and B MAC, does not process claims for hospice or home health services. However, we are responsible for reimbursement to A/B providers for certification and recertification of these services.
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View First Coast’s active / proposed LCDs / articles on CMS’ Medicare coverage database (MCD)
Florida hospice and home health claims are processed by Palmetto GBA as the regional home health intermediary (RHHI). National Government Services (NGS) is the RHHI responsible for Puerto Rico and the U.S. Virgin Islands.
Search for specific LCDs or procedure codes using the appropriate contractor's LCD lookup:
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
Audit and compliance
- CERT resources
- Recovery Auditor (RA) resources
- OIG report A-09-18-03031 -- CMS could have saved $192 million by targeting home health claims for review with visits slightly above the threshold that triggers a higher Medicare payment
- Provider Compliance Tips for Home Health Services
Education
Utilize educational information from First Coast and CMS on hospice/home health services.
- Upcoming events
- Visit On-Demand Learning – access First Coast’s webcast recordings, web-based training, videos and tutorials
Additional educational opportunities
View Palmetto GBA upcoming events -- Florida hospice/home health contractor
View NGS upcoming events -- Puerto Rico and U.S. Virgin Islands hospice/home health contractor
CMS educational opportunities
CMS Internet-only manual (IOM)
The CMS’ IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives. The following CMS IOM contains information specific to hospice and home health providers:
- Medicare Benefit Policy Manual, Chapter 7 Section 10.6
- Publication 100-04, Medicare Claims Processing Manual, Chapter 10 -- Home Health Agency Billing
- Publication 100-04, Medicare Claims Processing Manual, Chapter 11 -- Processing Hospice Claims
Resources
Visit the Hospice Center on the CMS website.
Visit the Home Health Agency (HHA) Center on the CMS website.
View additional resources identified specifically for hospice and home health services.
- CMS and contractor resources
- Professional associations
- General resources
Claims data - Denials, RTPs and Rejects (PartA)
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Resources/tips to avoid or correct reject reason code C7010
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Resources/tips to avoid or correct hospice overlapping an inpatient stay
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Avoid hospice rejects with these helpful tips
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Follow these resolution tips to avoid overlapping claims
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