New updates on Hospice claims

Effective with dates of service on or after July 1, 2012, note that Medicare will return hospice claims where:

Both condition code 52 and condition code H2 are present;

Condition code 52 is present and the patient status code is 30;

Condition code H2 is present and the patient status code is 30;

Condition code H2 is present with occurrence code 42; or

Condition code 52 is present with occurrence code 42.

Effective with claims submitted on or after July 1, 2012:

Medicare will pay revenue code 0657 when reported with a GV modifier appended to the HCPCS code at the lower of the submitted charge or 85% of the Medicare Physician Fee Schedule.

Medicare will adjust hospice claims already processed containing revenue code 0657 reported with a GV modifier appended to a HCPCS code if payment was made at 85% of the submitted charges and the claim is brought to the attention of your Medicare contractor within 6 months of the implementation date of CR7677, which is July 2, 2012.

When Medicare contractors deny hospice room and board charges, they will use claim adjustment reason code 96 for non-covered service and group code PR (Patient responsibility).

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7677.pdf