News From the End of Life

CMS tightens rules for processing claims

The Centers for Medicare & Medicaid Services (CMS) has published an educational article explaining the changes to the Health Insurance Portability and Accountability Act (HIPAA) claims processing requirements that will take effect on July 6, 2004. The changes affect all health care providers that bill Medicare fiscal intermediaries.

Medicare will now require certain data elements that are not needed for payment of Medicare claims but are required by HIPAA. Data that Medicare previously allowed but that are not permitted by HIPAA will result in claims rejection. Also, data that Medicare now edits only for syntax will be edited for content and will result in claims rejections if the data are not valid.

Examples of changes that can result in claims rejections after July 6 include:

  • For all home health claims, all line items must contain a date or dates of service for each revenue code, or it will be rejected.
  • Any claims that are not inpatient claims containing Covered Days (QTY Segment) will be rejected.

To view the article and for links to more technical documents related to the change, go to www.cms.hhs.gov/medlearn/matters/mmarticles/2004/MM3031.pdf.


Upcoming hospice educational events

The First National Conference on Pediatric Palliative and Hospice Care will be held Nov. 12-14 at the Hyatt Regency Dearborn, Dearborn, MI. This conference will comprise approximately two and a half days of plenary and concurrent sessions. It is jointly sponsored by the National Hospice and Palliative Care Organization and the Michigan Hospice and Palliative Care Organization.

Areas of emphasis include neonatal and pediatric pain and symptom management, spiritual needs, the role of advocacy, innovative collaborations, effective communication, bereavement, staff education, and research projects.

The National Hospice and Palliative Care Organization offers frequent audio conferences. Upcoming topics are:

  • May 13, "Updates in Pediatric Pain Control"
  • May 25, "Your Fiscal Intermediary and You"
  • June 10, "Palliative Approaches in End-Stage Respiratory Disease"
  • June 22, "General Inpatient Care."

For further information on these sessions, see: www.nhpco.org/templates/1/homepage.cfm.