CMS Cautions Hospices MUST Report Multiple Diagnoses on Claims

CMS officials announced they have concerns that hospices reporting a single diagnosis on claims are not providing an accurate description of the patients' conditions, and say providers must code and report coexisting or additional diagnoses in order to more fully describe the Medicare patients they are treating.

As part of the hospice wage index notice, which was reported in last week's Connections, CMS announced that recent analyses by Abt Associates (the hospice payment reform contractor) indicated that 77.2% of hospice claims from 2010 report only one diagnosis.

According to CMS, most Medicare patients at the end-of-life are elderly and likely have multiple diagnoses that relate to their terminal illness. Further, several coding manuals require reporting of all additional or coexisting diagnoses. And finally, as part of hospice payment reform efforts, CMS is considering, among other approaches, a case-mix adjustment system.

For these reasons, CMS has indicated that, to account for any clinical complexities a given patient might have as a result of related comorbidities, the diagnoses must be included on Medicare hospice claims. CMS further clarifies that the coexisting or additional diagnoses that are reported should be those that are related to the terminal illness, and that providers should not report coexisting or additional diagnoses that are unrelated to the terminal illness.

CMS stresses that this is part of longstanding policy in the Medicare hospice benefit, and reporting of coexisting or additional diagnoses related to the terminal illness will bring hospices into compliance with existing policy.

back  |  printer-friendly version