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Updated Reimbursement Rate for Routine Home Care Based on Length of Stay

July 2, 2019

Federal Rule 42 CFR Part 418, CMS–1629–F, RIN 0938–AS39 Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements establishes an updated reimbursement rate of differential payments for routine home care based on the recipient’s length of stay. This will implement a service intensity add-on (SIA) payment for services provided by a registered nurse or social worker in the last seven days of a recipient’s life for at least 15 minutes and up to four hours total per day.

The Department of Health Care Services (DHCS) will perform a one-time collection of National Provider Identifiers (NPIs) and Claim Control Numbers (CCNs) for providers who prefer to have multiple claims for dates of service on or after January 1, 2016, voided at one time. Once the mass void is complete, appeals may be submitted with the corresponding Remittance Advice Details (RAD) form and the indication in the Remarks field (Box 80) of the UB-04 claim form that the previous claim was voided.

The following example details submission of a mass void of many previously paid claims with HCPCS code Z7100 (routine home care [per diem]), for dates of service from January 1, 2016, through May 31, 2016, or revenue code 0651 (hospice service, routine home care) for dates of service from June 1, 2016, through May 1, 2018:

  • A provider previously submitted 100 claims for dates of service from January 1, 2016, through May 31, 2016, for HCPCS code Z7100, which have been adjudicated and the provider has received reimbursement.
  • The provider wishes to be reimbursed for the new rate amounts for the previously paid claims
    • 0650 (routine home care [high rate])
    • 0659 (routine home care [low rate])
    • 0552 (routine home care [SIA rate])
  • The provider compiles all CCNs and their NPI for each previously reimbursed claim and sends this list to HospiceEPC@conduent.com before September 30, 2019. At that time, CCNs will be submitted for a mass void. Providers should note that this process is subject to scheduling and may take up to six months for completion.
  • A mass void occurs for all the submitted CCNs, and the provider receives the voided RAD.
  • Within 90 days of receipt of the RAD, the provider submits the appeal with the voided RAD and corrected/updated claim with the new revenue codes to the California Medicaid Management Information System (MMIS) Fiscal Intermediary for reprocessing:
    • The provider indicates in the Remarks field (Box 80) that the previous claim was voided, along with the reason for the void and expectation to be reimbursed at the new routine home care rates.
    • The appeal is submitted within 90 days of the submission date on the voided RAD.
  • The reprocessing of the updated claim occurs and reimbursement finalizes, as appropriate, with the new rates.

  • Note:

    During this void/resubmission process, once the original claim has been voided, the original reimbursement will be taken back. Providers should account for this until the reprocessed claim is adjudicated and the new reimbursement occurs, as appropriate.

Additional information may be located under a previous Newsflash, published on April 9, 2018, titled, “Hospice Routine Home Care Updates.”