Fee-for-service hospice NF rates effective July 1, 2020 – June 30, 2021

REQUIREMENTS: - By July 1, 2020 (already effective): Billing team must update billing system to apply new per diem rates for revenue codes 658 (Basic NF: $334.87), 191 (Complex Medical NF: $468.82), and 192 (Pediatric NF: $775.87) for nursing facility room and board on Routine Home Care and Continuous Home Care days. - Before billing revenue codes 190 (NF Bariatric: $619.51) and 194 (NF Vent: $786.94): Obtain written DHS/AAA approval for each patient. Do not bill these codes without approval or claims will be denied. - Update billing software to enforce the 60-day billing threshold rule: Use revenue code 651 for RHC days 1-60 of hospice election, and revenue code 650 for RHC day 61 and beyond. - For readmissions: Implement logic to count prior hospice days within 60-day window; reset counting for readmissions more than 60 days after discharge; do not reset if patient changes hospice providers unless more than 60 days without service. - In institutional claim Value Code field: Enter value code '61' followed by applicable CBSA code as dollar amount (e.g., 13460.00 for Bend area). - Document and flag all services meeting Service-Intensity Add-on (SIA) payment criteria in last 7 days of patient life per MLN Matters MM9201; maintain records for future claim submission when OHA system is ready. - Billing staff must verify correct CBSA code for service location and apply corresponding per diem rates from rate table on Page 3. - Contact Jennifer Valentine (jennifer.b.valentine@dhsoha.state.or.us) for rate/billing questions or local DHS AAA/APD office for Level of Care requirements.