With the advent of the 2016 (Happy New Year!), hospices now face the revised hospice payment system. Specifically, Medicare will pay a higher routine home care rate for the first 60 days of care ($187 average) and a lower routine home care rate for days beyond 60 ($147 average). These adjustments are supposed to be approximately budget neutral.
The varied RHC payments will be calculated automatically by the contractors and do not require separate billing. But, hospices should monitor January billings carefully to ensure that payments under this new system meet defined expectations. Here are some of the specific rules:
- The new rate system will take effect midstream, so a patient admitted December 1, 2015 will have 29 days of remaining higher RHC eligibility in January 2016 (assuming continuous service).
- The 60 day higher RHC period will be counted only during days on service, so if a patient revokes and readmits, then the higher RHC period should span 60 payment days, not 60 calendar days;
- The 60 day higher RHC period will reset if a patient has been off service for at least 60 days. Although eligibility period counting will remain the same, the higher RHC payments are available, in theory, more than once for the same patient.
In addition, a service intensity add-on payment is available during the last seven days of life for certain services by hospice RNs and social works (but inexplicably not for LPNs; LPNs need better lobbyists apparently).