Hospice Final Rule Includes July Start for New Data Requirement

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By Terry Miller, RN 
Regulatory Analyst, McKesson

New Hospice Final Rule RequirementsThe Hospice FY2014 Final Rule that CMS released on August 7 includes a 1% payment increase for services rendered on or after October 1, 2013. It also includes a warning against using non-specific diagnoses and diagnoses that are the principal diagnosis and a requirement for hospices to use ICD-9-CM coding guidelines until ICD-10 goes into effect next October.

Of particular interest to hospices, the rule makes the Hospice Item Set (HIS) effective as of July 1, 2014. HIS is a standardized tool that includes seven NQF-endorsed measures of hospice patient care to be collected at admission and discharge:

  1. NQF #1617 Patients treated with an opioid who are given a bowel regimen
  2. NQF #1634 Pain screening
  3. NQF #1637 Pain assessment
  4. NQF #1638 Dyspnea treatment
  5. NQF #1639 Dyspnea screening
  6. NQF #1641 Treatment preferences
  7. Modified NQF #1647 Beliefs/values addressed (if desired by the patient)

In its fact sheet, CMS explains that an item set is a standardized mechanism for abstracting data from a medical record. In other words, hospices will not be capturing this information from patients; they will be mapping existing items in their clinical records to items in the HIS. Some providers will need/want to add HIS items to their clinical records or patient assessment forms.

Starting in July, hospices will submit an HIS admission record and an HIS discharge record for each patient. The admission form contains patient ID information and clinical items for calculating the seven quality measures. The discharge form contains patient ID and discharge information to determine patient exclusions for some of the quality measures. Hospices will have 14 days from admission to complete the admission record and seven days from discharge for the discharge record. All completed records must be submitted to CMS within 30 days.

Full details on completing and submitting the forms have not been published. A user manual is scheduled to posted on the CMS HQRP website in February, and CMS said it would hold an HIS training session that month. Draft technical information about the item set is available here. Once the user manual is released, we’ll be sure to update you on how this requirement is likely to affect your daily workflow.

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