Hi, Steve.
HealthCareFirst [our CareFacts/medical software provider] had a regulatory webinar back in September and I dug out my notes from that. I also found the webinar recording online and listened to the portions
that talked about the hospice diagnosis code change.
Per the Director of Regulatory Compliance who was hosting the webinar, she stated that Change Request 8877 talked about using correct diagnosis codes for dates of service effective 10/1/14 and later. She
stated they were looking for clarification from CMS on this and was hoping it would only regard new admissions that actually began 10/1/14 or later – NOT clients who had been admitted previous to 10/1/14 and who had continuing episodes which would include
services dates from 10/1/14.
She also stated that any claim returned to a provider for this edit would NOT be a denial for payment – rather, it would be returned for additional clarity.
Logically, I’m with you – if someone were admitted prior to 10/1/14 with a banned diagnosis code, you would think they’d be grandfathered in.
I haven’t had any October claims from pre-October admissions returned to me. I don’t know if that’s because we didn’t happen to use any of the forbidden codes for those folks OR if it’s because they were
indeed grandfathered in somehow.
Hope this was slightly helpful!
Jill Thomas
Accounting /Billing Specialist
Guardian Angels Elim Home Care and Hospice
403 Main Street, Elk River, MN 55330
Main 763-241-0654
Direct 763-452-4101
Email
jthomas@gaehc.org
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From: Hotvedt, Steve W [mailto:Steve.W.Hotvedt@HealthPartners.Com]
Sent: Friday, December 12, 2014 11:47 AM
To: Billers@list.mnhomecare.org
Subject: Hospice 485 question please
As of Oct 1st Medicare requires more specificity for ICD9 codes for dementia, sometimes involving a “partner” code.
We are questioning whether the 485 needs to be redone back to the beginning of the cert period that Oct 1st resides in for all the dementia patients affected .
I have searched high and low for the answer to that question with no success. Logic tells me that the dementia code which was accepted and legal at the beginning of the cert or election need not necessitate a new 485 back to that date,
when the only change required is a mandated revision for the same essential diagnosis.
I know that logic and medicare are two separate entities.
Does anyone out there have an answer for this question?
Steve Hotvedt
Healthpartners Hospice and Palliative Care
steve.w.hotvedt@healthpartners.com
Phone: 651-415-4015
Fax: 651-415-4010
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