This electronic Comparative Billing Report (eCBR) focuses on Non-Cancer Length of Stay (NCLOS) rates from April 1, 2016 to September 30, 2016. CBR information is one of the many tools used to assist individual providers to become proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare guidelines.
For your personalized NCLOS eCBR results, logon to eServices.
NCLOS Rates: Overview
NCLOS rates1 permit Palmetto GBA to characterize its entire hospice provider population using at least six months of claims data. This approach allows Palmetto GBA to document variations in the proportion of long-stay non-cancer patients (greater than 210 days) at the regional, state and provider levels. While this quantitative data does not necessarily reflect the appropriate or inappropriate provision of hospice services under Medicare, it does allow for the identification of trends and possible educational opportunities.
Any questions regarding the NCLOS rates may be directed to A.Policy@PalmettoGBA.com.
Your NCLOS rate is the percentage of your beneficiaries with a length of stay greater than 210 days and a primary diagnosis code billed on the hospice claim within the ICD-10-CM Category compared to all your beneficiaries within the same category. A blank field within the percentage column represents providers with no beneficiaries within that ICD-10 category. A zero within the percentage column represents providers with beneficiaries within that ICD-10 category but no beneficiaries exceeding a 210 day length of stay.
1NCLOS rate values may range from zero (no beneficiaries had lengths of stays greater than 210 days), to one (all had stays greater than 210 days). The units are per 100 beneficiaries (e.g., an NCLOS rate of 0.15 means that 15 beneficiaries out of 100 had stays greater than 210 days).
NCLOS Rates: Results
The NCLOS rates table below summarizes the experience of hospice providers submitting non-cancer claims to Palmetto GBA, for all non-cancer diagnosis categories by geographic region.
Palmetto GBA’s JM Home Health and Hospice Medicare Administrative Contractor (HHH MAC) includes 16 states. These 16 states may be divided geographically into four sub-regions: Southeast (Kentucky, North Carolina, South Carolina and Tennessee), Southwest (Arkansas, Louisiana, New Mexico, Oklahoma and Texas), Gulf Coast (Alabama, Florida, Georgia and Mississippi) and Midwest (Illinois, Indiana and Ohio). There are additional ‘other’ states that also submit claims to Palmetto GBA. Results for the ‘other’ states are combined.
|ICD-10-CM Category||Gulf Coast||Midwest||Southeast||Southwest||All 16 States||Other States|
|Certain Conditions Originating in the Perinatal Period||0.00||0.00||0.00||0.00||0.00||0.00|
|Pregnancy, Childbirth, and the Puerperium||0.00||0.00||0.00||0.00||0.00||0.00|
|Congenital Malformations, Deformations and Chromosomal Abnormalities||0.20||0.24||0.14||0.31||0.23||0.33|
|Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism||0.10||0.08||0.13||0.10||0.10||0.13|
|Diseases of the Circulatory System||0.24||0.18||0.19||0.24||0.22||0.21|
|Diseases of the Digestive System||0.07||0.05||0.07||0.09||0.07||0.06|
|Diseases of the Genitourinary System||0.07||0.06||0.06||0.07||0.07||0.04|
|Diseases of the Musculoskeletal System and Connective Tissue||0.18||0.19||0.15||0.24||0.20||0.13|
|Diseases of the Nervous System||0.31||0.27||0.27||0.34||0.30||0.30|
|Diseases of the Respiratory System||0.18||0.15||0.17||0.20||0.18||0.17|
|Diseases of the Skin and Subcutaneous Tissue||0.09||0.19||0.24||0.12||0.15||0.25|
|Endocrine, Nutritional and Metabolic Diseases||0.18||0.18||0.15||0.14||0.17||0.17|
|Infectious and Parasitic Diseases||0.02||0.02||0.02||0.03||0.02||0.02|
|Injury, Poisoning and Certain Other Consequences of External Causes||0.06||0.06||0.06||0.09||0.07||0.09|
|Mental, Behavioral and Neurodevelopmental Disorders||0.31||0.26||0.31||0.37||0.30||0.16|
|Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified||0.12||0.11||0.11||0.15||0.12||0.15|
|Total (All Conditions)||0.23||0.22||0.20||0.25||0.19||0.22|
Educational resources have been developed to address issues pertinent to this eCBR. Your facility is being advised to download and review the information attached below:
NCLOS rates by ICD-10 Category