Allegheny Messages

Hospice agencies will need to use Condition Code 85 to demonstrate a late Recertification on Claims as of January 1, 2017.  Agencies will be required to include Occurrence Span Code 77 with the dates not covered due to the untimely recertification.

To accommodate the new requirement the screen in Patient/Insurance/Hospice/Certification periods has been updated.  Agencies will now have the ability to enter Occurrence Span Code 77 with dates of non-covered days with Condition code 85 for Late Recertification.  Instructions are also included to be sure to update the entered start date for the certification period to reflect the first day of covered services.  Agencies will then need to modify the number of days of the period by the number of non-covered days.  The through date for the billing certification period will then remain consistent with the certification period on the patient’s Hospice Plan of Care.

The updated Start date for the certification period where there is a late recertification will cause the Occurrence Code 27 date on the claim to not overlap the Occurrence Span Code 77 date range.  Medicare will deny claims with a late recertification if Occurrence Code 27 falls with in the occurrence Span Code date range.

The Hospice Initial Election date, Non-covered days and KX Modifier due to a late Notice of Election have also been moved to the Hospice Certification periods tab for convenience.  The fields will still remain on the Hospice/Election Certification tab and if populated there, will populate on the Certification Period tab.