Hospice rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by section 1814(i)(1)(C)(ii) of the Social Security Act which also provides for an annual increase in payment rates for hospice care services. Rates for hospice physician services are not increased under this provision and are payable as billed, up to a per claim maximum of $200.00.
RHC Tiered Rate Structure
Federal Rule 42 CFR Part 418, CMS–1629–F, RIN 0938–AS39 Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements establishes an updated reimbursement rate of differential payments for routine home care (RHC) based on the beneficiary’s length of stay, and implements a service intensity add-on (SIA) payment for services provided by a Registered Nurse or social worker in the last 7 days of a beneficiary’s life for at least 15 minutes and up to 4 hours total per day.
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