Hospice Claims and Use of Debility, Adult Failure to Thrive, and Dementia Diagnoses

The Centers for Medicare and Medicaid Services (CMS) has released the FY2014 Hospice Wage Index Proposal which includes some details of the portion of the proposed rule related to multiple diagnoses on hospice claims and specifically the use of debility, adult failure to thrive and dementia as the principle diagnosis. CMS specified that hospices should not use these diagnoses as the principle diagnosis and “they will return to provider (RTP) claims with debility or adult failure to thrive as the principal diagnoses”.

The National Association for Home Care and Hospice (NAHC) has recommended that hospices review cases where these diagnoses are listed as primary. If theses cased clearly have another diagnosis that is considered as a principle diagnosis, the hospice should correct this for future claims.

For more information regarding the proposed changes as well as NAHC’s recommendations and plans for education on these diagnoses and the coding of related diagnoses for the near future, please go the NAHC website.

Until next time,

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