Untimely Face-To-Face Encounter
Untimely Face-To-Face Encounter
The Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, § 30.3 states that when a required face-to-face (FTF) encounter does not occur timely (within 30 days prior to the start of the 3rd or later benefit period), the beneficiary cannot be recertified, and thus, the patient would cease to be eligible for the Medicare hospice benefit. In these cases, the hospice must discharge the patient because he/she is no longer considered terminally ill for Medicare purposes.
Discharge Claim
In addition to the usual hospice claim information, the discharge claim should include the following information.
TOB (FISS Page 01) |
Enter 8X1 or 8X4 Note: X = 1 (non-hospital based) or 2 (hospital based) |
STMT DATES FROM (FISS Page 01) |
Enter the "from" date for the billing period. |
STMT DATES TO (FISS Page 01) |
Enter the "to" date as the last payable day, which is the last covered day in the benefit period. |
STAT (FISS Page 01) |
Enter '01' if the patient was discharged to home or self-care. Refer to the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual at www.nubc.org for a list of all patient status codes. |
REMARKS (FISS Page 01) |
Enter remarks indicating the reason for the discharge is due to an untimely face-to-face encounter. Include your initials and the date the remark was entered. |
When the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospice's failure to meet the FTF requirement, the Centers for Medicare & Medicaid Services (CMS) expects the hospice to continue to care for the patient at its own expense until the required encounter occurs. Once the encounter occurs, the patient can be readmitted, provided they meet all of the eligibility requirements, and the patient files a new election statement.
Updated: 04.11.16