Maintenance of Hospice

Procura® Health Management Systems

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Software version / Procura 8.0
Documentation version / 8.0
Last Update Date / 2014-07-21

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Table of Contents

Table of Contents

Setting up Hospice

Hospice License and Access Rights

Funder Information

Hospice Funder

To Add a Hospice Funder

Funder Agency Reference Label

Hospice FARLs and ERLs

FARL for Billing 15-minute Intervals

Billing Information

Billing Rate Records

Billing Rate Record Field Descriptions

Example Billing Rate Records for Level of Care

Example Billing Rate Records for Services Provided

Billing for Non-Injectable Prescriptions

Funder Department Billing

Episode Options – Default Episode Days

Lookup Tables

Plan of Care Information

Hospice Certification and Plan of Care (POC)

Medication Profile Example Layout

Custom Question for Episode Level of Care

Notice of Election Information

NQF 0209 Pain Measure Report

1

Setting up Hospice

Setting up Hospice

Hospice License and Access Rights

Hospice is a licensed Module. This Hospice license must be activated by Procura.

The following Access Rights must be provided:

Label / Description
Hospice - Access to Hospice / This grants the user access to be able to add a Hospice Type document.
Hospice Certification and Plan of Care Report / This will provide the user access to print the Hospice Plan of Care report.

Assessments | Hospice_Access_Rights.htm

Funder Information

Hospice Funder

All Funders needing to auto calculate the Hospice per diems will be required to be set up as a Hospice Funder.

Assessments | Funder.htm

To Add a Hospice Funder

  1. Go to Maintenance | Billing Setup | Funders Module. The Funder/Provider Module form displays.
  2. Click Add.The Funder/Provider Information window displays the General tab.

  1. In the Code textbox, type an identifier for your funder or provider, (e.g., MED HOME).
  1. In the Name textbox, type the name of your funder or provider, (e.g., Medicare - Patients Home/Res).
  1. From the Type drop-down box, select Pre-Defined.
  1. From the Class drop-down box, select Funder.
  1. From the ClaimType drop-down box, select Other.This claim type is required in order to calculate the Hospice per diems.
  1. Click the Hospice Funder checkbox.This is required in order to calculate the Hospice per diems and to be able to print the Hospice Plan of Care report.
  1. Fill in all other required information.
  1. Click the Departments tab.
  1. Click Add. The Funder Department Information window displays the General tab.

  1. From the Department drop-down box, select the department to which your funder belongs.
  1. Click the Billing tab.
  1. Click Yes to confirm.

  1. From the Invoice Number Grouping drop-down box, select an invoice grouping.Although this is not required for Hospice ANSI electronic billing, it is a required field on the Funder Billing form.An invoice grouping must be added in order to save the funder.Create a ‘non-invoice’ grouping, (i.e, No Grouping), and then attach it to your funder.The Invoice Groupings are created under Maintenance | Billing Setup | Invoice Number Groupings.
  1. Click the Use Contract Amount Billing checkbox. The contract amount is used for Funders that have negotiated contractual amounts for services which are different, usually less than the full retail amount of the service.Hospice billing requires that the per diem charges and service charges be reported on the claim.The account balance for a Hospice patient should not include the service charges.In order for the account balance to show only what is going to be paid, this option should be enabled for each funder. When the checkbox is enabled, the billing rate records will provide a field whereby you can enter a zero dollar amount for the services provided.
  1. From the Episode Options Default Episode Days spinbox select 60. When creating an episode for a Hospice funder the default episode length is determined by the patient’s benefit period.Setting the spinbox to 60 will apply the appropriate episode length based on the episode sequence number.If the sequence equals one or two, the episode stop date will be calculated to be 90 days past the start date.If the episode sequence is three or higher, the episode stop date will be calculated to be 60 days past the start date.

Episode Sequence Number / Description of how many days will be calculated before a stop date is inserted
1 or 2 / The episode stop date will be set to 90 days after the start date.
3+ / The episode stop date will be set to 60 days after the start date.
  1. Click OK to return to the Funder/Provider Information window.
  1. Click Yes to confirm.
  1. Click OK to return to the Funder/Provider Module form.

Assessments | To_Add_a_Hospice_Funder.htm

Funder Agency Reference Label

Hospice FARLs and ERLs

Procura uses several Funder Agency Reference Labels (FARLs) to support the Hospice solution and billing requirements. Billing FARLs and ERLs are required for the successful transmission of billing charges to CMS. Procura will provide an import file and facilitate a review of these references.

Your System Administrator must define a FARL with the label Hospice Settings.This is required for Hospice billing calculation functionality.

The following settings must be added to the hospice FARL:

Label / Value / Description
Medicare Funder / Yes / Additional validation and rules for Medicare Hospice will be applied to the billing calculation portion of Hospice Billing Per Diem Billing Calculation.
This setting is required in order to determine the default episode length of Medicare Hospice episodes. The first two episodes are 90 days and all subsequent episodes are 60 days.
Default Level of Care / RTN Home or GNL IP / Sets the default level of care that is created when a hospice episode is created. The standard abbreviations are used. Continuous Home Care cannot be selected as the default level of care.
Inpatient Respite Care can only be charged for 5 continuous days. For Continuous Home Care, if there are billable visits on a day where a hospice per diem would otherwise be calculated, the visits must total at least 8 hours. However, the visits do not need to be consecutive. If either of these rules is broken, a message will be generated in the Over-Service Template in the Billing module and the invoice that is created will be marked as Held in order to prevent it from being included in ANSI 837 exports.
Default Level of Care Service Type / <Billing Service Type> / Sets the billing service type to be used for the routine home care level of care that is created when a new episode is created.
Prevent Overlapping Levels of Care / Yes / Prevents overlapping levels of care during the billing calculation by modifying any existing levels of care when you edit or add one.
One Claim Per Month / Yes / Because hospice episodes are 90 or 60 days long, there can be months where two invoices would be created (one per episode), and thus two claims. To meet the Medicare hospice requirement to bill monthly, this setting allows multiple invoices in a single month to be combined in a single ANSI 837 claim, and allows payment information received via the ANSI 835 to be applied to multiple invoices.

FARL for Billing 15-minute Intervals

In order for you to be able to bill charges on the same invoice in 15 minute intervals, along with other charges per visit, your System Administrator must define a FARL with the name 15-Minute Units and a value of Yes. This FARL is used in conjunction with the UB-04 paper invoice and the ANSI 837 Institutional Export to convert billing charges to 15 minute units. If the billing rate is per unit, the 15-minute units function will occur on the service line when creating an ANSI 837 Institutional export file, or when printing a UB-04 invoice for a Hospice Episode, (i.e., an episode associated with a funder that has the Hospice box checked). However, if the billing rate is per visit, the 15-minute units function will not occur on the service line. Instead, the billing charges will be printed/exported as if the FARL was not enabled.

Note:When creating an ANSI 837 Institutional export file or when printing a UB-04 invoice, the billing rate requisition code must be one of the Level of Care codes for per diem services, (i.e., 0651, 0655, 0655).

Assessments | Hospice_FARLs.htm

Billing Information

Billing Rate Records

A billing rate record will need to be defined for all applicable Levels of Care and for all services being provided to the patient. The Hospice Level of Care billing per diems are based on the client’s participation in Hospice and the level of care that they are receiving.Procura will generate billing charges based on the client’s location and level of care. Individual visits for services delivered by Hospice staff are still entered as verified billable visits with a customary billing rate and will appear on the claim invoice.

Sample Billing Table:

Billing Rate Record Field Descriptions

Field Name / Description
Service Type / Describes the Level of Care and the services being provided.There is a 10 character limit for the Service Type.
Description / Further describes the Service Type.
Billing Type / There are three options; Regular, Expense and Mileage.Select Regular for all Hospice per diem records and for regular service records.
Trx. Type / There are three options depending on the Billing Type.For Regular billing types, Charge will be the only value available.Expense and Mileage types are also available.
Rate Grouper / There are two choices, Other and Therapy.Select Other for all Hospice per diems and regular service records.
Billing Code – Regular Rate / The Billing Code must match the HCPCS code;
Q5001- Hospice care provided in patient's home/residence
Q5002- Hospice care provided in assisted living facility
Q5003- Hospice care provided in nursing long term care facility (LTC) or non-skipped nursing facility (NF)
Q5004- Hospice care provided in skilled nursing facility (SNF)
Q5005- Hospice care provided in inpatient hospital
Q5006- Hospice care provided in inpatient hospice facility
Q5007- Hospice care provided in long term care hospice (LTCH)
Q5008- Hospice care provided in inpatient psychiatric facility
Q5009- Hospice care provided in place not otherwise specified (NOS)
Q5010- Hospice care provided in a hospice facility
Billing Rate – Regular Rate / Your billing rate.
Revenue Code – Regular Rate / Used if you are exporting billing charges for this record as Revenue to an external Accounting program.
Expense Code – Regular Rate / Used if you are exporting billing charges for this record as Expenses to an external Accounting program.
Contract Rate – Regular Rate / Enter zero dollars for the service records such as SN, MSW, HHA etc…The rate for these services will still show on the bill but payment processing will not be inflated with these charges.Only the Hospice per diem reimbursement amount will be summed in the outstanding balance.
Billing Code – Statutory Rate / Same as regular rate.
Billing Rate – Statutory Rate / Same as regular rate.
Revenue Code – Statutory Rate / Same as regular rate.
Expense Code – Statutory Rate / Same as regular rate.
Contract Rate – Statutory Rate / Same as regular rate.
Codes Auxiliary / Not needed.
Requisition / For Hospice Level of Care records, the Requisition Code must be a valid CMS Level of Care Revenue Code.
0651- Routine Home Care
0652- Continuous Home Care
0655- Inpatient Respite Care
0656- General Inpatient Care
Master Acct. / Not needed.
Discipline / For regular service records (no per diems), the Discipline must be a valid CMS Discipline;
HHA– Home Health Aid
MSW– Medical Social Worker
OT– Occupational Therapist
PT– Physio-Therapist
SN– Skilled Nursing
ST– Speech Therapy

Example Billing Rate Records for Level of Care

Service Type / Description / Billing Code / Billing Rate / Billing Units / Requisition Code / Discipline
RHC Home / Routine Home Care in home / Q5001 / As per CMS rates / Visit / 0651 / Not needed
CHC Home / Continuous Home Care in home / Q5001 / As per CMS rates / Units / 0652 / Not needed
RHC ALF / Routine Home Care in ALF / Q5002 / As per CMS rates / Visit / 0651 / Not needed
CHC ALF / Continuous Home Care in ALF / Q5002 / As per CMS rates / Units / 0652 / Not needed
RHC LTC / Routine Home Care in Nursing LTC / Q5003 / As per CMS rates / Visit / 0651 / Not needed
CHC LTC / Continuous Home Care in Nursing LTC / Q5003 / As per CMS rates / Units / 0652 / Not needed
IRC LTC / Inpatient Respite Care in Nursing LTC / Q5003 / As per CMS rates / Visit / 0655 / Not needed
RHC SNF / Routine Home Care in SNF / Q5004 / As per CMS rates / Visit / 0651 / Not needed
IRC SNF / Inpatient Respite Care in SNF / Q5004 / As per CMS rates / Visit / 0655 / Not needed
GIP SNF / General Inpatient Care in SNF / Q5004 / As per CMS rates / Visit / 0656 / Not needed

Example Billing Rate Records for Services Provided

Service Type / Description / Billing Code / Billing Rate / Billing Units / Requisition Code / Discipline
PT / Physical therapy / G0151 / $200.00 / Visit / 0421 / PT
OT / Occupational therapy / G0152 / $200.00 / Visit / 0431 / OT
ST / Speech language pathology / G0153 / $200.00 / Visit / 0441 / ST
RN / Registered Nurse / G0154 / $200.00 / Visit / 0551 / SN
LPN / Licensed Practical Nurse / G0154 / $200.00 / Visit / 0551 / SN
MSW visit / Medical social service (visit) / G0155 / $200.00 / Visit / 0561 / MSW
MSW call / Medical social service (phone call) / G0155 / $200.00 / Unit / 0569 / MSW
HHA / Home health aide / G0156 / $200.00 / Visit / 0571 / HHA

Billing for Non-Injectable Prescriptions

Non-injectable prescription drugs must be reported on claims on a line-item basis per fill, based on the amount dispensed by the pharmacy. The NDC qualifier represents the quantity of the drug filled, and shall be reported as the unit measure.