The Affordable Care Act (ACA) mandates that a physician or nurse practitioner (NP) have a face-to-face encounter with certain long-stay hospice patients. The proposed implementation of this requirement is included in the "Home Health Prospective Payment System Rate Update for Calendar Year 2011" proposed rule. Please see the home health proposed rule (CMS-1510-P) for details, including the procedures for submitting comments. - CMS-1523-NC (Publication Date: July 22, 2010): The Centers for Medicare & Medicaid Services (CMS) issued a notice to update the Medicare Hospice Wage Index for fiscal year (FY) 2011. This notice implements the second year of a 7-year phase-out of the hospice wage index budget neutrality adjustment factor (BNAF), which was finalized in the FY 2010 final rule. As a result of this notice, the BNAF will be reduced by an additional 15% (for an overall 25% reduction) in FY 2011. This notice also solicits public comments on two possible approaches to modernizing the hospice aggregate cap calculation. The combined effects of an additional 15% reduction to the BNAF in the FY 2011 Hospice Wage Index, updated wage data, and a 2.6% hospital market basket update are estimated to increase payment to hospices in FY 2011 by 1.8 percent (an estimated $220 million).
- Physician consultation codes no longer valid for Medicare: In December 2009, CMS issued CR6740 [PDF 244KB] instructing that as of January 1, 2010, CPT consultation codes 99241-99245 and 99251-99255 are no longer valid for Medicare Part B billing. Because this affects Part A billing, as well, CMS will be issuing a separate CR to address Part A billing as it relates to these services. In the interim, hospices should look to CR6740 [PDF 244KB] for instructions (excluding those related to the use of an "AI" modifier) as to how to bill for these services.
- There are several new Q&As posted, dealing with physician narratives, charges on claims, and social worker calls. Please go to the "How to Stay Informed" section of this page and click on "Questions and Answers: Hospice".
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