Date: July 3, 2019
To: Enrolled Hospice Agencies
Re: Chapter K-200, Handbook for Hospice Agencies
Hospice Billing Changes Regarding Service Line Date and Occurrence Code Requirements Effective with Dates of Service on and after August 1, 2019
This bulletin informs hospice agencies of billing changes needed to properly identify the correct dates to assess Routine Home Care (RHC) high and low rates. It also instructs providers to use Occurrence Code 55 (Date of Death) that will help to identify eligible days for Service Intensity Add-on (SIA) payments in the last seven days of life, particularly if those last seven days of life cross calendar months. These billing changes are effective with dates of service on and after August 1, 2019 and apply to Medicaid fee-for-service claims as well as HealthChoice Illinois managed care claims.
· Service Line Date Requirement
Effective with dates of service on and after August 1, 2019, the Department will require providers to report the service line date on all hospice services. The Department already requires Revenue Codes 0652 – Continuous Home Care, 055X – Registered Nurse Service (SIA Add-on), and 056X – Social Work Services (SIA Add-on) to be billed by separate service line date to identify the service units billed each day.
· For Revenue Codes 0651 – Routine Home Care, 0655 – Inpatient Respite Care, 0656 – General Inpatient Care, 0657 – Physician Services and 0658 – Nursing Home Room and Board
UB-04 Billing: As these services are all reimbursed on a per-day basis, providers may combine the total number of days for one revenue code on one line showing the beginning service date in FL 45 and the total number of days in FL 46, as long as the service dates are consecutive.
837I and Medical Electronic Data Interchange (MEDI) Billing:
Electronic claim submission allows a beginning and ending service date range. Multiple days may be billed on one service line as long as the service dates are consecutive.
For Both UB-04 and Electronic Claims:
If the service dates are not consecutive, providers need to split the dates for that revenue code on a separate service line rather than combining the days on one line. This is especially important in allowing the Department to calculate the RHC high/low payment rate accurately.
Revenue Code 0651 for RHC will no longer need to be separately identified by service date if the provider is also billing for an SIA revenue code (055X or 056X) on the same date.
· Occurrence Code 55 Requirement
Effective with dates of service on and after August 1, 2019, to more precisely calculate SIA days, the Department will require providers to identify Occurrence Code 55 and the Date of Death on all claims for which SIA charges are made. Occurrence Code 55 and the Date of Death should be submitted on the claim preceding the month the patient died and also submitted on the claim for the month in which death occurred, if the SIA days cross calendar months. For claims where the SIA days cross calendar months, the first claim will identify a death date that is after the Statement Covers Period “Through” date. Claims containing charges for SIA days must contain Occurrence Code 55/Date of Death or the Department will ignore the charges for the SIA add-on on the claim.
· New Error Codes Associated with these Changes:
K19 – Statement Thru Date > Date of Death on Claim
K20 – Missing Service Line Date on Hospice Claim
These billing changes have been incorporated into Appendix K-2 of the Handbook for Hospice Services. Questions regarding this bulletin may be directed to the Bureau of Hospital and Provider Services at 877-782-5565.
Instructions for updating the Handbook for Hospice Agencies: