Hospice Documentation

Hospice Levels of Care: Inpatient Respite Care

There are four levels of care in the Medicare hospice benefit. Hospices are paid a per diem rate based on the number of days and level of care provided during the election period. The four levels of care are routine home care, continuous home care, inpatient respite care and general inpatient care. This job aid will focus on the inpatient respite level of care.

Inpatient Respite Care

Medicare covers two levels of inpatient care:

  • respite care for relief of the patient’s caregivers, and
  • general inpatient care which is for pain control and symptom management.

Inpatient respite care is provided to the patient only when necessary to relieve the family members or other caregivers that are caring for the patient at home. Coverage for respite care does not require that a worsening of the patient’s condition precede the respite stay. Respite care is short-term inpatient care and is reimbursed for no more than five consecutive days at a time. This care is provided on an occasional basis. Any number of situations may necessitate respite care.

Inpatient respite care may be provided directly by the hospice agency or indirectly under arrangements made by the hospice. Respite care must be provided by a hospice, hospital, skilled nursing facility or intermediate care facility that meets the standards for respite care set forth in regulation.

Billing

Payment at the inpatient respite care rate can be made for no more than five consecutive days at a time. Every day of inpatient respite care beyond the fifth consecutive day is billed and paid at the routine home care rate (revenue code 0651). Beneficiaries who elect the hospice benefit may be charged for a coinsurance equal to five percent of the payment for a respite care day.

The admission day is billed at a respite level of care (revenue code 0655). The day of discharge is billed at the RHC level of care (revenue code 0651), unless the patient dies or moves to another level of care. When the patient dies as an inpatient, the discharge day is billed at the inpatient respite care rate (revenue code 0655). If the patient remains in the respite level of care for more than five consecutive days, each day beyond the fifth day must be billed at the routine level of care. Providers may not bill the routine level of care for day six and then begin billing the respite level of care again starting on day seven.

When there is more than one respite period in the billing period, the provider must include the M2 OSC for all periods of respite. The span dates will represent the date of admission through the fifth consecutive day of respite or the last day the patient was in the inpatient respite level of care through midnight, whichever is sooner. For example, if the patient was in the inpatient respite level of care from 7/1/XXXX–7/5/XXXX and went back to the RHC level of care in their private residence on 7/5/XXXX, the OSC M2 would be reported with 7/1/XXXX through 7/4/XXXX. If the patient was in the inpatient respite level of care from 7/1/XXXX–7/8/XXXX and went back to the RHC level of care in their private residence on 7/8/XXXX, the OSC M2 would be reported with 7/1/XXXX through 7/5/XXXX. See examples below for proper line item reporting when the inpatient respite stay exceeds five consecutive days.

Note: CR 8569 implements system edits to prevent payment of respite care for more than five days at a time for any hospice claim submitted on or after 7/1/2014. This instruction will enforce the current policy that limits payment of respite care to no more than five consecutive days. Since respite care is payable only for periods of respite up to five consecutive days, claims reporting respite periods greater than five consecutive days will be RTP.

Inpatient Respite Billing Examples

One Respite Stay

The patient has one respite period at an inpatient hospice within the billing period (7/1/XXXX–7/31/XXXX). The respite period is 7/5/XXXX–7/9/XXXX. The patient was at the RHC level of care in their private residence all other days during the month.

Claim Page 2 Level of Care Reporting

Claim Line Revenue Code HCPCS Code Units Service Date
1 0651 Q5001 4 0701XX
2 0655 Q5006 4 0705XX
3 0651 Q5001 23 0708XX*
*The date of discharge from the inpatient respite level of care is billed at the RHC level of care since the patient did not die or go to another level of care.
  • HCPCS code Q5001 is reported for the hospice care provided in a private residence.
  • HCPCS code Q5006 is reported for the inpatient hospice level of care provided at a hospice facility.

 

Two Respite Stays

 

The patient has more than one respite period at an inpatient hospice within the billing period (7/1/XXXX–7/31/XXXX). The first respite period is 7/1/XXXX–7/3/XXXX. The second respite period is 7/15/XXXX-7/18/XXXX. The patient was at the RHC level of care in their private residence all other days during the month.

Claim Page 2 Occurence Span Code Reporting

OSC* 1 M2 0701XX -0705XX 2 M2 0715XX -0717XX


Claim Page 2 Level of Care Reporting

Claim Line Revenue Code HCPCS Code Units Service Date
1 0655 Q5006 2 0701XX
2 0651 Q5001 12 0703XX
3 0655 Q5006 3 0715XX
4 0651 Q5001 14 0718XX


*When more than one respite stay occurs in the same month, the OSC M2 must be reported for each respite stay.

Respite Stay that Exceeds Five Consecutive Days

The patient has one respite period at an inpatient hospice within the billing period (7/1/XXXX–7/31/XXXX). The respite period is 7/12/XXXX–7/18/XXXX. The patient was at the RHC level of care in their private residence all other days during the month.

Claim Page 2 Level of Care Reporting

Claim Line Revenue Code HCPCS Code Units Service Date
1 0651 Q5001 11 0701XX
2 0655 Q5006 5 0712XX
3 0651 Q5010 1 0717XX*
4 0651 Q5001 14 0718XX


*Each day beyond the fifth consecutive day of inpatient respite care is billed at the RHC level of care with the appropriate location HCPCS code

  • HCPCS code Q5010 is the hospice home level of care provided at a hospice facility

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