CBSA Codes and Hospice Payment Reform

CBSA Codes -

The FFY 2016 CBSA’s delineations effective October 1, 2015 have been updated and uploaded into NCTracks. Providers are encouraged to resubmit Hospice claims that were previously denied for CBSA Codes: 35100, 50103, 50104, 50105, 50106, 50107, 50108, 50109, 50110, 50111, and 50112 with a date of service on or after October 1, 2015.

Hospice Payment Reform -

DMA is also currently reviewing CMS guidance issued on Hospice Payment Reforms. The reform consist of service intensity add-on payments for hospice social worker and registered nurse visits provided during the last 7 days of life when provided during routine home care. Payment reform will also include the implementation of two routine home care rates, paying a higher rate in the first 60 days of a hospice election and a lower rate for days 61 and later.

Although the effective date of the Hospice Payment Reform of Routine Home Care (RHC) rates is January 1, 2016, system programming and policy development requirements will delay implementation of the reform until further notice.

Hospice providers are encouraged to continue to file claims using the current Hospice fee schedule posted on DMA’s website. Providers are encouraged to track episodes of care as well as visit data. When system updates have been completed, this type of tracking may assist provides with performing a reconciliation of their payments.

Additional information will be communicated when it becomes available. Should you have any questions, please contact Michelle Counts in Provider Reimbursement at 919-814-0059.