Publisher's Synopsis
The Hospice Guide to Billing and Reimbursement:
Durable Guidance and Strategy for a Shifting Payment Landscape
Casey Grimes
Catherine Stapleton, MS
This book will help you understand:
- Regulators' expectations surrounding billing and reimbursement for the Medicare hospice benefit
- Recent updates to payment terms, such as the introduction of the Service Intensity Add-on (SIA) and the two-tiered reimbursement structure for the provision of routine homecare
- What you need to do to prepare for the major changes still ahead (e.g., value-based purchasing models)
- How not to leave money on the table--or be penalized unnecessarily
Table of Contents:
- Today's Hospice Reimbursement and Billing Landscape at a Glance
- Overview of the Medicare hospice benefit
- Foundations of hospice billing and reimbursement
- Key developments in recent years
- Large-scale changes on the horizon
- Linking Hospice Philosophy, Care Practices and Outcomes, Operational Processes, and Received Payment
- Promoting Ongoing Compliance With Long-Standing Components of Hospice Payment and Billing
- Honoring patient eligibility requirements
- Understanding sequential billing
- Distributing Medicare coverage notices
- Creating effective cost reports
- Responding to additional development requests (ADR)
- Withstanding audits
- Adapting Practices and Processes to Accommodate Recent, Industrywide Payment Rate and Process Changes
- The SIA and two-tiered RHC payment model introduced through 2016 rulemaking
- Recent adjustment to hospice caps calculation methodology
- Integrating the hospice PEPPER report (including recently updated coverage areas) into internal billing compliance initiatives
- Adhering to quality reporting expectations to avoid payment penalties
- Promoting timely filing of election notices and recertifications, as well as timely completion of face-to-face documentation
- Curbing high rates of recertification and revocation
- Implementing effective compliance strategies surrounding the launch of ICD-10 and general coding-related practices (including clinical documentation) that can influence payment
- Recognizing and Readying Internal Systems for the Prospective Impact of Continuumwide Payment Reform Initiatives
- Value-based purchasing
- Bundled payments
- Accountable care organizations (ACO)
- Implementing Enduring Billing Best Practices, Strategies, and Systems to Facilitate the Receipt of Deserved Reimbursement
- Complying with setting-specific guidelines, rules, and regulations, especially those governing hospitals, skilled nursing facilities, and assisted living facilities
- Developing effective initial and ongoing staff training
