Last October, Palmetto, one of the nation’s largest Medicare Administrative Contractors to the federal government, released their Electronic Comparative Billing Report (eCBR) for 2018 data between April 1 – September 30 that focused on hospice providers’ Non-Cancer Length of Stay (NCLOS) rates. The NCLOS rates provided by the eCBR are important metrics that providers can utilize to become proactive in identifying issues with their billing processes and developing a plan to conduct internal audits to ensure compliance with Medicare guidelines. It can also help providers develop educational opportunities to assist in closing gaps in staff knowledge to avoid potential future challenges.
According to Palmetto, your NCLOS rates are obtained by taking the percentage of your beneficiaries with a length of stay greater than 210 days and a primary diagnosis code billed on the hospice claims within the ICD-10-CM category and comparing them to all your beneficiaries within the same category. NCLOS rates have a range from zero to one. A zero is given when no beneficiaries had lengths of stay greater than 210 days, and one is given when all beneficiaries had lengths of stay greater than 210 days.
Diseases of the nervous system with a length of stay greater than 210 days were the main highlights of the eCBR results. All Palmetto regions had consistently higher lengths of stay in this ICD-10 category, ranging from 26/100 beneficiary stays in the Southeast, 33/100 stays in the Southwest, 31/100 stays in the Gulf Coast, and 28/100 stays in the Midwest. The diseases of the nervous system are G00-G99 ICD-10 codes, which include commonly seen diagnoses like Alzheimer’s, dementia, Parkinson’s, ALS, and senile degeneration of the brain.
The full grouping of diseases of the nervous system ICD-10 codes are as follows:
|ICD-10 Codes||Grouping of Diseases of the Nervous System|
|G00-G09||Inflammatory diseases of the central nervous system|
|G10-G14||Systemic atrophies primarily affecting the central nervous system|
|G20-G26||Extrapyramidal and movement disorders|
|G30-G32||Other degenerative diseases of the nervous system|
|G35-G37||Demyelinating diseases of the central nervous system|
|G40-G47||Episodic and paroxysmal disorders|
|G50-G59||Nerve, nerve root and plexus disorders|
|G60-G65||Polyneuropathies and other disorders of the peripheral nervous system|
|G70-G73||Diseases of myoneural junction and muscle|
|G80-G83||Cerebral palsy and other paralytic syndromes|
|G89-G99||Other disorders of the nervous system|
The following are useful tips on how to get the most positive impact from your Palmetto NCLOS rates:
Once you review your provider report, you’ll have a better idea of what data Palmetto is seeing for your provider number and can develop an appropriate plan of action specific to your organization if needed. If your organization doesn’t have the resources available to properly utilize Palmetto’s NCLOS eCBR results, consider using a third-party consulting firm like McBee to develop a plan and resources, conduct off-sites reviews, and educate your staff.
About the Author
Dee Geray, RN, is a Clinical Consulting Manager at McBee with more than 20 years of experience working in the hospice industry. She has extensive expertise in hospice clinical compliance, case management, and leadership.