Financial Management & Compliance Flashcards

Under the Medicare hospice benefit, Routine Home Care is paid at two rates. When does the lower RHC rate begin?

Answer: Day 61 of hospice care

Since 2016, RHC pays a higher rate for days 1-60 and a lower rate from day 61 onward.

What is the inpatient day limitation for Medicare hospice providers?

Answer: Inpatient days (GIP + respite) may not exceed 20% of total patient care days

Total inpatient days (general inpatient plus respite) cannot exceed 20% of a hospice's total Medicare patient days in a cap year.

The Service Intensity Add-on (SIA) payment applies to which visits?

Answer: RN and social worker visits during the last 7 days of life on RHC days

SIA pays an hourly rate (up to 4 hours/day) for RN and social worker visits in the final 7 days of life when the patient is on RHC.

A hospice that fails to submit required Hospice Quality Reporting Program data faces what penalty, effective FY2024?

Answer: A 4 percentage point reduction to its annual payment update

The Consolidated Appropriations Act, 2021 raised the HQRP non-compliance penalty from 2 to 4 percentage points starting FY2024.

Continuous Home Care is billable only when care is provided during a crisis for at least how many hours in a 24-hour day?

Answer: 8 hours, more than half by nurses

CHC requires a minimum of 8 hours in a 24-hour day, with more than half provided by an RN or LPN.

Within how many calendar days after the election date must a hospice file the Notice of Election (NOE) with its MAC?

Answer: 5 calendar days

The NOE must be submitted and accepted within 5 calendar days of the election, or the hospice cannot bill for the untimely days.

How is a hospice's Medicare aggregate cap year defined since FY2017?

Answer: Aligned with the federal fiscal year, October 1 through September 30

CMS aligned the cap accounting year with the federal fiscal year (October 1 to September 30) beginning with the 2017 cap year.