The Alliance is aware of a few situations causing HOPE records to be rejected upon submission. These are outlined below, and we will update this thread with information from CMS on how these will be handled.
A1400 Payer Information
The Guidance Manual instructs to check all existing payer sources at the time of the assessment. And, more specifically, "If the patient had Part C/Medicare Advantage prior to enrolling in hospice, select the response options for BOTH part C and traditional fee-for-service Medicare or Medicaid, as applicable." However, rejections are occurring if both A1400A Medicare Traditional FFS and A1400B Medicare Advantage are chosen. Hospices may choose to check only one of these items in order to avoid the rejection.
J0905-J0910 Pain
The Guidance Manual skip pattern instructs to move to J2030 if J0905 Pain Active Problem is answered "No". However, numerous hospices are seeing HOPE records rejected if this instruction is followed. Inquiries were made to the iQIES help desk where hospices were told that J0910A cannot be skipped and must minimally be answered "No". This is not consistent with the Guidance Manual and the Data Specs; however, hospices may choose to complete J0910A to avoid the rejection.
Active Diagnosis Item
We are investigating potential rejection issues in this area as well. Again, this thread will be updated when more information is available.
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Katie Wehri
Vice President of Regulatory Affairs, Quality & Compliance
National Alliance for Care at Home
Washington DC
+1 (202) 547-7424
kwehri@allianceforcareathome.org------------------------------