Blue Cross is changing its reimbursement policy for prehospice services

Blue Cross Blue Shield of Michigan created the prehospice benefit to improve quality of care for patients with advanced illnesses. The benefit provides increased access to hospice and palliative care services.

Blue Cross commercial members with the prehospice benefit may receive coverage for counseling, education and support services delivered by participating hospice providers.

Please note:

• Prehospice services are payable for members who may not be eligible for hospice care or do not wish to enroll in it.
• Members may continue receiving treatments directed toward curing their disease while using prehospice services.

Currently, hospice providers performing prehospice care can bill revenue code 0691 regardless of the nature of the visit performed. But effective March 1, 2016, there will be two billable levels of prehospice care:

1. Consultation and education for prehospice and palliative care services (revenue code 0694) should be billed if the nature of the visit is purely educational or consultative. This includes:
• Promoting an understanding of palliative care
• Informing the patient about the availability of hospice care services
• Answering questions and discussing options
2. A charge for a prehospice or palliative care visit (revenue code 0691) should be billed if the visit involves additional aspects of patient care. This includes:
• Clinical decision-making
• Symptom management
• Delivery of other tangible support or skilled care services

Blue Cross members with prehospice coverage have a lifetime limit of up to 28 prehospice visits. The 28-visit limit includes a combination of both revenue codes 0691 and 0694. These visits are not charged against the patient’s hospice day or dollar benefit maximums. To determine if a member has prehospice coverage, please refer to PARS and the web-DENIS Subscriber Information screens.

The new prehospice reimbursement amounts will be included with the hospice rate schedule. The schedule will be available on web-DENIS on or before Dec. 1, 2015. As a reminder, prehospice and hospice rate updates will take effect March 1, 2016.

Clarification about maximum coverage amount

Updates to the maximum coverage amount for 2016 will be effective Jan. 1. But as of Oct. 1, 2016, Blue Cross will be updating its annual adjustments to the hospice maximum coverage amount in accordance with the Centers for Medicare & Medicaid Services’ published hospice cap. You can access information about CMS’ annual hospice cap and effective date through the CMS website by clicking here.**

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