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Hospice Item Set (HIS)

About this Page

The Hospice Item Set (HIS) web page provides updates, announcements, and resources specific to the HIS. On this page you will find direct links to the HIS, the HIS manual, fact sheets, and training materials. Announcements related to HIS activities (such as trainings and OMB approval) are posted here.

The content on this page relates to HIS items and data collection only; if you are looking for information on HIS-based quality measures, including measure specifications, visit the “Current Measures” portion of this webpage.  

For questions related to content posted on this page, please contact the Quality Help Desk at HospiceQualityQuestions@cms.hhs.gov.

Updates

September 28, 2017

Replacement Pages Available for the Hospice Item Set Manual V2.00 Pages 2A-8 and 2A-9 to support the New Medicare Cards Initiative

Starting in April 2018, CMS will be issuing New Medicare Cards to replace the Social Security (SSN)-based Health Insurance Claims Numbers (HICNs). This initiative was previously known as the Social Security Number Removal Initiative (SSNRI). Pages 2A-8 and 2A-9 of the HIS Manual V2.00 have been updated to reflect these changes, and to provide coding guidance for the affected item (A0600B Medicare number). Updated replacement pages for 2A-8 and 2A-9 are available in the Downloads section of this page. Download and save the replacement manual pages to ensure your coding guidance is up to date.

To update your existing paper version of the HIS Manual V2.00, download the PDF version of the replacement pages. Print and replace these pages accordingly in your HIS Manual V2.00, to save from re-printing the full manual.

If you have an existing electronic copy of the HIS Manual V2.00 or need to download the Manual for the first time, the replacement pages can also be found in the HIS Manual V2.00 .zip file, in the Downloads.

June 20, 2017

Question and Answer (Q+A) Document for the Second Quarter of 2017 Now Available

A new Question and Answer (Q+A) document is now available in the “Downloads” portion of this webpage. The Q+A document reflects frequently asked Hospice Item Set (HIS) related questions that were received by the Quality Help Desk during the second quarter (April-June) of 2017. This document also contains quarterly updates and events from the second quarter as well what’s coming up in the third quarter.”

June 14, 2017

Based on questions received on the Hospice Quality Help Desk, CMS is clarifying coding guidance for Response option J, Self-pay for Item A1400 on V2.00.0 of the Hospice Item Set (HIS). CMS recommends that providers review the updated guidance below for additional instruction on selecting response option J, Self-pay for A1400. Master guidance on A1400 can be found in the downloads section below.

  • For purposes of completing Item A1400, the minimum threshold for a “self-pay” patient would be ability to pay for any low-cost medication, supply or service (e.g., medication co-pay or over-the-counter medication). Based on this definition of self-pay, for certain providers, a large majority of patients may be identified as self-pay; this is acceptable.
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  • Select response option J if the patient has any amount of personal funds available to contribute to healthcare expenses during the hospice episode of care. CMS recommends selecting this response option if the patient is paying for or able to pay for any of their own medications, supplies, services, room and board, etc.
  • Self-Pay should be chosen even if the patient is not actively paying for anything, but could pay for something or has the funds if needed. Additionally, the intent of the self-pay response option is not to assess patients’ ability to self-pay, but rather to determine availability of funds to cover costs of care. Selecting the self-pay response option obligates neither the hospice nor the patient to use those funds to pay for care, should a need to self-pay arise. In this sense, collection of data to complete Item A1400 should not influence the delivery of hospice services based on the patient’s ability to self-pay for care, or based on availability of other pay sources the patient may have. This HIS item is not used for quality measure calculation.
  • For the purposes of completing Item A1400, existence of pay sources can be based on patient/caregiver report, and gathering additional supplementary financial information is not likely to be necessary. It is possible to collect the information during the referral/intake/admission process when verifying insurance sources, or during preadmission/admission discussions of what the hospice benefit will cover and what the patient may be responsible for. CMS understands that these conversations may take place as part of an overall assessment of the patient’s ability to pay for such items that may not traditionally be paid for by the Hospice Benefit.

April 25, 2017

Question and Answer (Q+A) Document for the First Quarter of 2017 Now Available

A new Question and Answer (Q+A) document is now available in the “Downloads” portion of this webpage. The Q+A document reflects frequently asked Hospice Item Set (HIS) related questions that were received by the Quality Help Desk during the first quarter (January-March) of 2017. This document also contains quarterly updates and events from the first quarter as well what’s coming up in the second quarter.”

January 19, 2017

Updated HIS Manual V2.00 and Associated Change Table Now Available

An updated version HIS Manual V2.00 is available as a .zip file download at the bottom of this webpage. This version contains a correction to the HIS Discharge in Appendix D. This version of the HIS Manual accompanies V2.00.0 of the HIS that will be effective April 1, 2017. Also included in the .zip file is a change table that outlines major changes from the HIS Manual V1.02 to V2.00.

IMPORTANT: Hospice providers should review all Final Validation reports to confirm successful submission and processing of HIS data

As part of the HIS reporting requirements, hospices must submit required HIS–Admission and HIS-Discharge records to CMS’s Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system. In order to successfully submit records to the QIES ASAP system, HIS data must be converted into the proper electronic file format (XML) using either the Hospice Abstraction Reporting Tool (HART) software, which is free to download and use, or a vendor-designed software.

Please note that when an HIS file is uploaded to the QIES ASAP system, providers should receive two confirmation messages: an “Upload Completed” message and a “Submission Received” message. These confirmation messages only indicate that the file has been submitted to QIES; they do not indicate that the file has been successfully processed and received by CMS. Once a file is submitted, it may take up to 24 hours for processing to complete. When processing is complete, providers should return to the Hospice File Submission system to verify the status of the file and then proceed with locating the system-generated Hospice Final Validation report in the CASPER Reporting application to verify that all records were successfully processed without error. To demonstrate compliance with HIS reporting requirements, providers should print and retain Final Validation reports as evidence of successful submission and processing of HIS records. Please note that hospice reports are automatically removed from the CASPER Reporting application after 60 days.  If 1) a Final Validation report is not received following the submission of HIS records or 2) a Final Validation report is received with fatal errors listed, the submission and processing was not successful. In these instances, the provider must correct any errors and resubmit relevant HIS records to the QIES ASAP system. For instructions detailing how to check the submission status of a file and access Final Validation reports, please refer to Appendix A of the CASPER Reporting Hospice Provider User’s Guide: https://www.qtso.com/download/Guides/hospice/cspr_appA_hospc_prvdr.pdf.  If you have any questions about verifying that a submission was successfully received and processed, please contact the QTSO Help Desk at help@qtso.com  or at 1-877-201-4721 (Monday-Friday from 7:00 AM – 7:00 PM CT).

Compliance with HIS reporting requirements is determined based on HIS data that is successfully submitted to and processed by the QIES ASAP system. If a Final Validation report demonstrating successful submission and processing is not received, this indicates that the relevant HIS record was not received by CMS and thus the hospice may not be in compliance with HIS reporting requirements and may be subject to a 2 point reduction in their APU determination.

December 01, 2016

HIS Manual V2.00 and Associated Change Table Available in “Downloads” Below

The HIS Manual V2.00 is available as a .zip file download at the bottom of this webpage. This version of the HIS Manual accompanies V2.00.0 of the HIS that will be effective April 1, 2017. Also included in the .zip file is a change table that outlines major changes from the HIS Manual V1.02 to V2.00.

August 04, 2016

Supporting Analyses for Updates to the HIS V2.00.0 now available

A summary of supporting analyses for updates made to V2.00.0 of the HIS is now available in the “Downloads” portion of this webpage. The analyses presented in the document are findings from the HIS V2.00.0 pilot study and a technical expert panel. Analyses support the following additions that were made to the HIS V2.00.0: new section and items added in the HIS-Discharge record to collect data for the Hospice Visits when Death is Imminent Measure Pair and new item added to Section J: Pain in the HIS-Admission record. The HIS V2.00.0 is scheduled to be implemented April 1, 2017.

Hospice Quality Reporting Archives

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