Modification to Hospice Day Count for Two-Tier Calculation

This notice is in regard to Hospice claims that were adjudicated in NCTracks beginning Jan. 1, 2016.

As per the FY 2016 Hospice Wage Index and Payment Rate Update final rule, the Centers for Medicare & Medicaid Services (CMS) mandated two-tier hospice day count pricing effective January 1, 2016. On Nov. 1, 2017, NCTracks system changes were implemented and all claims for hospice service began to be reimbursed in accordance with the requirements of Hospice Payment Reform.  

It was determined that NCTracks system updates were required to correct the two-tier day count based on the hospice election date. This NCTracks system change will be implemented on July 28, 2019, with a retroactive effective date of January 1, 2016.

For more information on the two-tier hospice day count reimbursement, please see the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47172), CMS updates to the final rule, the January 2016 Medicaid Special Bulletin, and the October 2016 Medicaid Bulletin.

*All claims affected by this change will be reprocessed at a later date. Affected providers will be notified through future Medicaid Bulletins and/or NCTracks Provider Communications regarding the claims reprocessing schedule.