HOSPICE FACILITY GENERAL INFORMATION

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1 I. BCBSM s Hospice Program HOSPICE FACILITY GENERAL INFORMATION The BCBSM Hospice program provides benefits for eligible members for medical, psychological, social and spiritual services for terminally ill patients and their families. Hospice care primarily focuses on the reduction of the physical and psychological symptoms of a patient diagnosed with a terminally ill disease. Certification of a terminal diagnosis must be signed by the patient's attending physician. Hospice care focuses on providing treatment that reduces or relieves the physical and psychological symptoms of a patient's terminal disease, rather than actively seeking a cure. This type of care is also referred to as palliative treatment. Traditional Participation with Blue Cross Blue Shield of Michigan s (BCBSM) Traditional program is on a formal basis only for all hospice facilities (whether hospital owned or not). Services provided in a non-participating Hospice are not reimbursed by BCBSM to either the facility or the member. The following information applies to facilities that want to participate in BCBSM's network for members enrolled in our Traditional product. Please note, however, that members enrolled in BCBSM s PPO and Point Of Service products (e.g., Community Blue PPO, Blue Preferred PPO, Blue Preferred Plus PPO, Blue Choice POS, etc.) use the BCBSM Traditional network unless a separate network for hospice services has been established for those members. Members of other Blue Cross Blue Shield (BCBS) Plans also use the Traditional network. Member benefits and eligibility should be verified for all BCBSM or BCBS members before providing services. Medicare Supplemental Patients who have primary coverage through Medicare may also have Medicare Supplemental coverage through BCBSM for nursing home care with hospice support (fifth level of care)the effective date of a facility's eligibility to receive payment for the BCBSM Medicare Supplemental program coincides with its Traditional program effective date. II. BCBSM s Hospice Qualification Requirements In order to participate with BCBSM a Hospice program must, at minimum, have and maintain the following: Current Medicare certification as a hospice agency Licensure as a hospice by the state of Michigan Membership in either: The National Hospice and Palliative Care Organization, or The Michigan Hospice and Palliative Care Organization A multi-disciplinary staff composed of the following: a Michigan licensed physician medical director to provide overall direction for the clinical aspect of hospice services Revised: July

2 registered nurses who provide or supervise the nursing care requirements of patients a licensed social worker a pastoral or bereavement counselor. a volunteer staff sufficient to provide administrative or direct patient care equaling at least five percent of total patient hours of patient care provided by all paid employees and contract staff In addition, the facility must have and maintain the following general requirements that include: facility must provide the following services: physical therapy, occupational therapy, speech and language therapy, home health aide, medical supplies/equipment, drugs and biologicals, and short term inpatient care facility has written policies and procedures that meet generally acceptable standards for hospice services to assure the quality of patient care, and facility demonstrates compliance with such policies and procedures facility maintains a ratio of at least 80 percent home care days and no more than 20 percent inpatient days for BCBSM members facility can demonstrate that it conducts program evaluation and utilization review to assess the appropriateness, adequacy and effectiveness of the program's administrative and clinical components facility meets BCBSM's Evidence of Necessity (EON) requirements, if applicable facility has a governing board that is legally responsible for the total operation of facility. The governing board, or as an alternative, a community advisory board responsible to the governing board, shall include persons representative of a cross section of the community who are interested in the welfare and proper functioning of facility as a community agency. facility has an absence of inappropriate utilization or practice patterns, as identified through valid subscriber complaints, audits and peer review facility has an absence of fraud and illegal activities facility maintains adequate patient and financial records Note: It is BCBSM s policy to recredential participating providers every 2-3 years to verify continued compliance with all qualification requirements. III. Levels of Care A Hospice facility is responsible for providing and coordinating all services to treat a patient's terminal illness, and related conditions, including appliances, durable medical equipment, medical supplies, radiology, lab and drugs. The facility must be able to provide either directly, or through contractual arrangements, routine home care, continuous home care, inpatient respite care, and general inpatient care as described below. 1) Routine Home Care Routine home care consists of services provided to patients who are living at home and are not receiving continuous home care, as described below. Routine home care includes such services as nursing, counseling, home health aide and physical therapy. Routine home care is provided less than eight continuous hours per day. 2) Continuous Home Care Nursing care provided to hospice patients during crisis periods to enable patients to stay in their home. Continuous home care is provided eight or more hours per day. 3) Inpatient Respite Care Revised: July

3 Inpatient respite care consists of short-term inpatient services provided to allow the patient's home-care providers short periods of relief. Care must be: provided on a non-routine and occasional basis provided in increments of five days or less during any 30-day period provided by the hospice facility s own inpatient unit (that meets Medicare s standards for inpatient care), or by one of the BCBSM participating facilities below: a hospital that contracts with the hospice a Skilled Nursing Facility (SNF) that contracts with the hospice 4) General Inpatient Care General inpatient care consists of inpatient services provided for pain control, or acute or chronic symptom management that cannot be provided in other less intensive settings. General inpatient care must be provided by the hospice facility s own inpatient unit (that meets Medicare s standards for inpatient care) or by one of the following types of BCBSM participating facilities: a hospital that contracts with the hospice a Skilled Nursing Facility (SNF) that contracts with the hospice 5) Nursing Home Care with Hospice Support* Nursing Home Care with Hospice Support consists of care provided in a nursing home to patients who are medically stable but unable to return home because of their need for assistance and the unavailability of a primary care provider. Nursing home care with hospice support must be provided by one of the hospice facility's own inpatient units (that meets Medicare s standards for inpatient care) or by one of the following facilities: a BCBSM participating hospital that contracts with the patient's specified hospice a licensed and Medicare certified Skilled Nursing Facility (SNF) that contracts with the patient's specified hospice *Nursing home care with hospice support is a level of hospice care that is a benefit only for certain customer groups, however, it is not required to be provided by all BCBSM participating hospice facilities. IV. Hospice (Freestanding and Hospital-based) Facility Reimbursement There are for five levels of care listed on the BCBSM Hospice Provider Rate Schedule (Rate Schedule). Each level of care on the Rate Schedule has an assigned all-inclusive maximum payment rate. BCBSM will reimburse Facility the lesser of billed charges or the maximum payment rate on the Rate Schedule. The Rate Schedule for each primary location will vary depending on the Medicare defined geographic area the facility is located in. BCBSM will reimburse Facility according to the Rate Schedule in effect on the date the Covered Service was provided. In addition, Facility is reimbursed a separate fee for direct care visits provided by physicians employed by or under contract with Facility. The fee is limited to the lesser of Facility s billed charge or the BCBSM (physician) Traditional Product Maximum Payment Schedule that is in effect on the date of service. Covered Services provided by physicians who are not employed by or under contract with Facility are separately reimbursable to such physicians. Participating Hospice providers are required to bill BCBSM for all covered hospice services and to accept BCBSM's payment as payment in full for covered services, except for any member copayments and/or deductibles. BCBSM will reimburse the facility for covered services provided at its primary location and all Medicare and BCBSM approved branch locations according to the Revised: July

4 BCBSM Rate Schedule applicable to its primary location. The Rate Schedule is BCBSM s standard rate schedule and is not negotiable. V. The BCBSM Participation Agreement The Hospice facility participation agreement is available on the bcbsm.com Hospice home web page. The agreement is also available as a link in the participation chapter of the provider manual on web-denis for those providers that already have web-denis access. The participation agreement is on file with the Michigan Office of Financial and Insurance Regulation (OFIR) and its terms and provisions are not negotiable. The applicable participation agreement signature document for each BCBSM network/program being requested on the application is available on the Hospice home web page and must be completed, signed and returned with a completed facility application form. NOTE: This is general information only and is subject to change without notice. After we review the application and accompanying documentation, we may contact the designated representative of the facility to set up an appointment for an on-site visit. The on-site visit includes a review of a sample of medical records to evaluate the applicant's compliance with BCBSM requirements, as outlined in this application. The facility must be ready for the on-site review at the time of submitting the application. If the facility is approved for program participation, the appropriate notification will be issued. If the facility is not approved, we will send notification in writing indicating the reason(s) for the denial. The facility may not submit claims and is not eligible for reimbursement unless and until the facility s application for participation is approved by BCBSM and BCBSM has issued a signed letter of approval to the facility for the networks requested. The effective date for the approved networks will be indicated in the approval letter sent to the facility. Effective dates are not retroactive to the date the application was submitted or received. A separate BCBSM facility code is assigned to each approved and contracted primary location. Approved branch locations use the same facility code as the primary location when submitting claims to BCBSM. With the implementation of the National Provider Identifier (NPI) BCBSM crosswalks the claims from the facility s NPI to the BCBSM (primary) facility code (i.e., BCBSM s internal identifier) for processing. Therefore, BCBSM recommends obtaining one NPI (in accordance with federal guidelines), for each primary Hospice location and each provider type. Federal guidelines also allow for an NPI to be obtained for unique combinations of tax ID, location and taxonomy (specialty) codes. Upon completion of the application and contracting process, the facility will receive a welcome package with information on how to sign up for electronic billing and access to web-denis, BCBSM s web-based information system for providers. Through web-denis the facility will have access to provider manuals, newsletters (e.g., The Record), and patient data such as contract eligibility and benefits. It is the facility s responsibility to be familiar with and to adhere to all BCBCM billing and benefit requirements. It is also the responsibility of the facility to ensure its billing department (or billing agency) is compliant with all of BCBSM's billing requirements. Participating Hospice facilities must bill BCBSM on a UB- 04 claim form or its electronic equivalent. BCBSM no longer accepts facility paper claims (with some exceptions). Facilities that would like more information about internet claims submission or who wish to bill electronically should contact Revised: July

5 BCBSM's Electronic Data Input (EDI) Helpline at (800) for electronic billing information after their BCBSM facility code has been received. Facilities that participate in the Traditional program must notify BCBSM immediately of any change in the facility s ownership, tax identification number, Medicare certification, CMS certification number, addition/deletion of branch locations, NPI, address, telephone number, etc. Multiple Locations If the facility is applying for participation (or an ownership change) for multiple locations, a separate application must be completed for each primary location with a separate NPI. If the facility has multiple branch locations (extensions), please list them in the appropriate section of the application. Each site must meet all qualification standards in order to be approved. A separate BCBSM provider code is issued for each approved primary location with a separate NPI. This same facility code should also be used when billing for services provided at the primary facility s approved branch locations. Revised: July

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