Payment Rates

30.2 - Payment Rates (Rev. 3378, Issued: 10-16-15, Effective: 01-01-16, Implementation: 01-01-16) The CMS publishes general hospice payment rates annually to be used for revenue codes 0651, 0652, 0655, and 0656. These rates must then be adjusted by the A/B MAC (A) based on the beneficiary’s locality. National rates are issued as described below. These rates are updated annually and published in the “Recurring Update Notification.” This example is the national rates for October 1, 2004, through September 30, 2005. Description Revenue Code Daily Rate Wage Amount Non-weighted Component Routine Home Care 0651 $121.98 $83.81 $38.17 Continuous Home Care Full Rate = 24 hours of care; $29.66 hourly rate 0652 $711.92 $489.16 $222.76 Inpatient Respite Care 0655 $126.18 $68.30 $57.88 General Inpatient Care 0656 $542.61 $347.32 $195.29 For claims with dates of service on or after January 1, 2016, there are two hospice routine home care (RHC) rates. A hospice day billed at the RHC level in the first 60 days of a hospice election is paid at the high RHC rate. A hospice day billed at the RHC level on day 61 or later of the hospice election is paid at the low RHC rate. Medicare systems count 60 days from the date of admission regardless of whether some days are covered or non-covered. For a hospice patient that is discharged and readmitted to hospice services within 60 days of the discharge, the hospice days will continue to follow the patient. If the hospice patient is discharged from hospice care for more than 60 days a new election to hospice will initiate a reset of the patient’s 60-day window, paid at the RHC high rate upon the new admission. Example: • Patient elected hospice for the first time on 01/10/XX. • The patient revoked hospice on 01/30/XX. • The patient re-elected hospice on 02/16/XX. • The patient discharged deceased from hospice care on 03/28/XX. Since the break in hospice care from 01/30 to 02/16 was less than 60 days the patient day count continues on the second admission. RHC provided during first election from 01/10 to 01/30 accounts for 21 days that the high RHC rate would apply. The 60 day count continues with second admission on 2/16 and the high RHC rate would apply for an additional 39 days. Day 61 begins the low RHC rate on 3/27. Multiple RHC days are reported on a single line item on the claim. The line item date of service represents the first date at the level of care and the units represent the number of days. As a result, both high and low RHC rates may apply to a single line item. Extending the example above, if the March claim for this patient consisted entirely of RHC days at home, the payment line item would look like this: Revenue Code HCPCS Line Item Date of Service Units 0651 Q5001 03/01/XX 31 Medicare systems would: • calculate the dates from 3/01 to 3/26 at the high RHC rate, • calculate the dates from 3/27 to 3/31 at the low RHC rate, and sum these two amounts in the payment applied to this line item.