Agencies will need Main Office software version 5882 dated 12-17-15 or later to accommodate Routine Home Care charges for Medicare Hospice days 1-60 (High Rate) and day 61 and after (low rate) to begin January 1, 2016. Service set up will now have a new data entry field. Agencies will need to use their current Routine Home Care service. NO ADDITIONAL SERVICE CODE SHOULD BE CREATED OR ENTERED IN THE SOFTWARE. Agencies who enter and update yearly the current Routine Home Care rates in the billing rate field in the Service Billing Rate tab will need to update the billing rate field with the Routine Home Care rate for days 1-60 (high rate). An additional field has been added under a new section “Hospice Routine Charges Posting”. The field is labeled “Hospice Routine Charges 61+days rate. Agencies will need to enter the Routine Home Care rate for day 61 and after (low rate).
If your agency is using the system calculated Hospice rates and the check mark is in place to “Use system calculated Hospice rates based on national payment rates adjusted for wage index”, no updates to the service set up are needed.
The software will calculate and post the correct high and low rates to the routine charge when posting Routine Hospice charges through the Billing Utility- Hospice Routine Charges. The software will use the Start Of Care date as entered in the patient demographics screen as day one when counting hospice days for each patient.
All agencies will need to indicate if a patient used Hospice days at another agency or in a different election period within the past 60 days of the current election. The number of days used previously must be counted and a Date entered in the Patient/Insurance/Hospice tab in the Election/Certifications/CHAPS tab to indicate when the low rate, day 61 or after should be applied to generated Routine charges using the Billing Utility to Post hospice Routine Charges.
The software will use the additional fields to calculate the anticipated invoice total and will post this invoice total when Accounts Receivable is updated during invoice or electronic claim generation process in the software.
As a reminder per Medicare requirements, both high and low routine charges will be included in the total dollar amount on the same summary line for routine charges on paper invoices and electronic claims. You will not see line items separating the two rates.