Ill. HFS Handbook for Hospice Agencies, Topic K-250.6

Effective with service From Dates on and after January 1, 2016, an SIA payment

may be billed for visits by a social worker or registered nurse (personnel defined in

42 CFR Part 418.114), when provided during routine home care during the last

seven days of life. The SIA payment is in addition to the RHC payment. The SIA

hourly rate is derived from the hospice Continuous Home Care hourly rate and is

payable in 15-minute increments (one unit = 15 minutes).

The eligible SIA payment revenue lines may only encompass at a maximum the last

seven days of life. The maximum number of hours allowed per day is four hours (16

units) for either the social worker services or registered nurse services or a

combination of the two services. If more than 16 units per day are billed for either

055X or 056X, the claim will reject. If the combination of 055X & 056X exceeds 16

units per day, the additional units will be ignored, as long as neither 055X nor 056X

exceed the maximum individually. If the number of SIA days billed is less than

seven, the provider may only bill the maximum units allowed per day. To receive the

SIA, the claim must contain routine home care Revenue Code 0651.

Billing for Registered Nurse Services – Services provided by a registered nurse

must be billed with HCPCS code G0299 and Revenue Code 055X.

Billing for Social Work Services – Services provided by a social worker must be

billed with HCPCS code G0155 and Revenue Code 056X. This service may not be

provided by a social worker via telephone.

If SIA days cross calendar months, the Department must have the initial month’s

claim in payable status before the hospice bills the last claim identifying patient

death. The Department will run a monthly report on participants where the following

conditions are met:

• The Department received a claim identifying patient death.

• The patient had SIA days in the month of death.

• The patient mathematically could have received SIA days in the previous month.

The Department will make payment adjustments for those earlier claims to

reimburse the hospice for the SIA days billed on the initial claim. The Adjustment

Reason Code appearing on the Remittance Advice for these claims will be 3566 –

Service Intensity Add-on Adjustment.

Any SIA date must be tied to a date for RHC in order to be reimbursed. Revenue

code 0651 (RHC) associated with an SIA day, plus revenue codes 055X (registered

nurse service) and/or 056X (social work service), must be billed by individual

service date. If there are no SIA days associated with specific RHC days, RHC

revenue code 0651 may be billed for multiple service units (FL 46).