When home health and hospice care overlap in a patient’s home, it can become a headache for home health agencies. Home health may bill the care if the hospice decides it’s not related to the terminal diagnosis.
If there is a circumstance where the care is entirely unrelated to the terminal diagnoses and comorbidities of the patient, then home health can bill for it. But this is a unique situation, and hospices have the right-of-way.
Communication is key
Proper billing requires the agency to communicate with the hospice provider to understand all the conditions covered under the hospice stay. If the patient’s condition is not associated with the hospice benefit, the agency should bill the services on the RAP and final claim with condition code 07.
Dissect the care you are providing to hospice patients to ensure it isn’t related to their need for hospice care. Wound care after a fall, for example, could be a legitimate billable home health service, but only if it’s completely unrelated to the diagnosis that has the patient in hospice.
Diagnosis vs. prognosis
Consider this: A patient falls and cuts his leg, but the reason for the fall is an ALS diagnosis. The hospice agency can bill for wound care, but the home health agency cannot.
If the cause of the fall was due to opioids prescribed as pain management for their terminal prognosis, CMS expects that hospice would bill for wound care for the patient, not home health. But, on the other hand, if the patient tripped over a dog toy or slipped in a puddle, home health can provide care for that wound.
It’s not a single diagnosis that home health agencies need to avoid; it’s the overall prognosis. The home health agency can still have some of the same diagnoses on their plan of care as the hospice if it’s unrelated to the terminal prognosis.