In the News: Governmental Agency Activities

Centers for Medicare and Medicaid Services [CMS]

• Acceptable Physician Signature Format

Included in the release of Change Request (CR) 5550 and during discussion at the CMS Home Health, Hospice and Durable Medical Equipment Open Door the issue of acceptable formats for physician signatures was raised. With the release of CR 5550, acceptable physician signature formats were revised. Hospice providers were informed that they could not use electronic physician signatures for the Certification of Terminal Illness. In addition, hospice providers were informed that faxed signatures were also not acceptable. However, as a result of ongoing clarification and provider activity in this area, CMS recently released an update to this important aspect of care and has stated that faxed hand written physician signatures are acceptable. It is important to note that stamped signatures are not acceptable signatures and do not meet Medicare and Medicaid Requirements. CMS’s clarification permits hospices to obtain either faxed or electronic physician signatures for the certification of terminal illness.

• Reconsideration Appeal Form Revised

CMS’s Request for Reconsideration form has been revised and is now available. The revised form and a description of the changes can be found in the CMS issued Change Request [CR]5836. This form is used during the reconsideration appeal process at the second level of appeal for a claim denial, and requests the use of a Qualified Independent Contractor (QIC) when the intermediary’s redetermination decision has denied the claim. Use of the revised form begins in mid February. Details and the revised form are available by accessing www.cms.hhs.gov/transmittals/downloads/R1408CP.pdf.

• Requests for Anticipated Payment (RAPs) Problems

Also of note during the CMS Home Health, Hospice and Durable Medical Equipment Open Door Forum, was the confirmation that system problems were affecting the home health provider RAPs and claims processing. Claims are being held up in the processing cycle due to several identified issues. Examples of issues included claims for care that straddled 2007-2008, non-recognition of Core Based Statistical Area codes in rural areas with service dates on or after January 1, and invalid treatment authorization codes on claims. Providers need to check the error messages being received and closely review claims and consider contacting their intermediaries about accelerated payment options.

Office of the Inspector General [OIG]

The Office of Inspector General (OIG) of the Department of Health & Human Services has released its “Medicare Hospice Care: A Comparison of Beneficiaries in Nursing Facilities and Beneficiaries in Other Settings” report. Both the hospice and nursing facility provider community have been anticipating this report. Some of the key findings, based upon 2005 data, include:

• Hospice beneficiaries within all settings contained similar characteristics, such as race and eligibility criteria.
• The average age of nursing facility hospice patients was 84, which was three years older than hospice patients cared for in other settings, who averaged 81 years of age.
• Length of stay for Hospice beneficiaries in nursing facilities averaged 80 days, while Hospice beneficiaries in other settings average length of stay was only 62 days.
• 28% of Medicare hospice beneficiaries resided in nursing facilities for at least a portion of the time while receiving hospice services.
• 48% of hospice beneficiaries in nursing facilities had terminal diagnoses of less specifically defined/not easily classified conditions (such as debility, adult failure to thrive and senility), mental disorders or Alzheimer’s diseases as compared to only 23% of hospice beneficiaries in other settings.
• 20% of hospice beneficiaries in nursing facilities had a cancer diagnosis, while 41% of hospice beneficiaries in other settings had a cancer diagnosis.

The full OIG report is available by accessing the OIG website: www.oig.hhs.gov. As a result of this study’s findings, the OIG recommends that a second study be completed focusing in more depth on key aspects of this study.