Situation Report | January 25, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) has added hospice Continuous Home Care services to the list of audit topics under its Recovery Audit Contractor (RAC) program.
This review will determine if hospice Continuous Home Care services were reasonable and necessary to achieve palliation and management of the patient’s acute medical symptoms to maintain the terminally ill patient at home, based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied.
Affected REV codes include:
- 0652 – Continuous Home Care
- 0551 – Skilled Nursing Visit
- 0571 – Home Health Aide Visit
HCPCS codes include:
- G0299 – Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes
- G0300 – Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes
- G0156 – Services of home health/hospice aide in home health or hospice settings, each 15 minutes