Blue Cross Newsletter
 

 

January 8, 2010

 

 

HP – 10-01
To:

All Blue Cross Hospice Contracting Providers
From:

Cindy Garrison, Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Subject:

Federal Employee Program (FEP) Hospice Continuous Care Benefit

 

Hospice Continuous Care Benefits

Beginning January 1, 2010, Federal Employee Program (FEP) will provide benefits for Hospice Continuous Care services. 

FEP defines Hospice as an integrated set of services and supplies designed to provide palliative and supportive care to members with a projected life expectancy of six months or less due to a terminal medical condition, as certified by the member's primary care providers or specialist.

 

Benefit

Standard Option

Basic Option


Continuous Home Hospice Care

Prior Approval Required

Services provided in the home to members enrolled in home hospice during a period of crisis, such as frequent medication adjustments to control symptoms or to manage a significant change in the member's condition, requiring a minimum of 8 hours of medically necessary care during each 24-hour period by a registered nurse (R.N.) or licensed practical nurse (L.P.N.).


Preferred: $200 copayment per episode for up to 7 consecutive days of care

Member: $350 copayment per episode for up to 7 consecutive days of care

Non-member: $350 copayment per episode, plus 35% MAP, and any remaining balance after our payment for up to 7 consecutive days of care


Preferred: $150 per day copayment up to $750 per episode for up to 7 consecutive days of care

Member/Non-member:  All charges are patient responsibility

NOTE: Members must receive prior approval for each episode of continuous home hospice care.  An episode consists of up to seven consecutive days of continuous care.  Each episode must be separated by at least 21 days of traditional home hospice care.  The member must be enrolled in a home hospice program and the continuous home hospice care services must be provided by the home hospice program in which the member is enrolled.

BILLING:
Use revenue code 0652 with HCPCS code T2043 and bill each hour as one unit.  It is important that you bill the correct number of units as our allowance is per hour. 

As indicated in Policies and Procedures, BCBSKS inpatient and home hospice MAPs will be adjusted to reflect the Contracting Provider's current Medicare rate upon notification by the provider.  This change will be effective the first of the month following notification.  Therefore, beginning January 1, 2010, the hourly BCBSKS MAP for Hospice Continuous Care will be the Medicare rate divided by 24 (Medicare's rate indicates a 24-hour rate).

You are required to submit medical records for the day(s) approved for continuous hospice care.  There should be hourly documentation of interventions provided to the member by the R.N. or L.P.N. while they were in attendance.  In addition to the medical records, you will also need to submit a copy of the prior approval letter with the claim.

As stated above, in order to qualify as hospice continuous care, you must provide a minimum of 8 hours of medically necessary care during a 24-hour period.  When continuous care is prior authorized and approved, records must support the medical need for a minimum of 8 hours of care per day. If records reviewed are determined by BCBSKS to not support the minimum requirement, the claim will be denied.  When this happens, home hospice may be billed in lieu of continuous care for that day(s).  A new claim will need to be submitted using revenue code 0651 in lieu of 0652 to receive the daily home hospice rate. While a HCPCS code is not required with revenue code 0651, you can use one as long as it is valid.  Your prior approval for hospice continuous care will be accepted in lieu of a home hospice approval.  Be sure to submit your prior approval letter with your paper claim or include the prior authorization number in the treatment authorization field on the electronic claim.

Complete FEP benefit information is available at
http://www.bcbsks.com/CustomerService/Providers/index.htm

FEP eligibility and claim status information is available by calling the BCBSKS customer service center at 785-291-4181 or 1-800-432-0379. 

CG