Report Hospice Quality Data to Avoid Payment Penalty

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By Terry Miller, RN, COS-C 
Regulatory Advisor, McKesson

A nurse documenting hospice quality reportingYour hospice agency has only until April 1, 2014, to submit required data for the Hospice Quality Reporting Program that’s mandated by the Affordable Care Act.

All Medicare-certified hospices that have a valid CMS Certification Number (also known as a Medicare Provider Number) as of March 3, 2014, are required to collect and submit to CMS data on:

  • The structural measure
  • NQF #0209 Pain Measure on all admissions from January 1, 2013, through December 26, 2013

As specified by CMS, Medicare-certified hospices that fail to report this data will receive a 2% reduction in their annual payment for the 2015 fiscal year that starts October 1. During this reporting period, the performance on the standards does not matter because the penalty is not tied to the score. Rather, the penalty is tied to a failure to report.

Data for both measures must be submitted to CMS using The Technical User’s Guide for Hospice Quality Reporting Data Entry and Submission web-based data entry system. Data is required for the entire calendar year 2013 as opposed to quarterly or monthly data reporting.

We’ve reported this before, but please remember that Medicare-certified hospices will need to collect on every patient the Hospice Item Set (HIS) and HIS Discharge data items and submit them electronically to CMS beginning July 1, 2014. For more information on this issue, see the FY2014 Hospice Wage Index Final Rule.

CMS also published the HIS Manual and held its HIS education the week of February 3, 2014. CMS recommends that hospices familiarize themselves with the HIS Manual and take advantage of the February education recordings.

The following information can assist your planning:

The Affordable Care Act and new quality and reimbursement initiatives have been fundamentally transforming how hospice agencies operate. If you haven’t yet explored a hospice software solution for agency management that can automate many reporting tasks and help your staff focus more fully on providing care, the upcoming Hospice Quality Reporting Program deadline can be a timely reminder.

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