Description
Home Health Services related to a Hospice terminal diagnosis provided during a Hospice period are included in the Hospice payment and are not separately payable.
Affected Code(s)
Revenue Codes: 0023X, 042X, 043X, 044X, 055X, 023X, 056X, 057X
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
2. 42 CFR §405.929- Post-Payment Review
3. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
4. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
5. 42 CFR §405.986- Good Cause for Reopening
6. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
7. Medicare Claims Processing Manual, Chapter 11, §50- Billing and Payment for Services Unrelated to Terminal Illness
8. Medicare Benefit Policy Manual, Chapter 9, §10 - Requirements – General, §40.1.9 - Other Items and Services