Hospices Seek Expanded Claims Codes for Chaplain Services

Hospice and spiritual care organizations and advocacy groups are calling for the widespread establishment of Healthcare Common Procedure Coding System (HCPCS) codes for chaplain services on Medicare claims. While such a move would not impact the amount of hospices’ per diem reimbursement, the codes would allow providers to gather data regarding an essential component of their interdisciplinary teams.

The requests made earlier this month by hospice advocates and providers included revisions to the U.S. Centers for Medicare & Medicaid Services (CMS) HCPCS that would broaden the applicability and scope of chaplain care in hospice. Currently, three existing HCPCS codes exist for hospice spiritual care that include assessment and individual and group counseling, but these only apply to chaplaincy services within the Veterans Health Administration or those provided by the Department of Veteran Affairs (VA).

“It’s very, very difficult to generalize any discipline’s slice of the pie in relation to hospice staffing hours, because it depends on each hospice agency and their particular staffing productivity and ratio model, but you really need a way to capture that information,” said Charles Parker, director of the hospice and palliative care division at the Spiritual Care Association. “We have proven through the VA that it is successful, and we can go from there and expand upon this. It’s going to take a bit of time to have the data to show the quality of spiritual care and this is a baby step, but it’s a huge step in the right direction.”

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The request came from the HealthCare Chaplaincy Network (HCCN) in collaboration with the Spiritual Care Association and advocacy groups such as the National Hospice & Palliative Care Organization (NHPCO). Supporters cited the need for “standardized data for budgeting and quality purposes,” which was also the rationale for establishing these codes within the VA system.

Applying the codes to health care settings beyond the VA would help provide valuable and economical care to patients by giving hospices measurable and accountable ways to record chaplain visits and services, according to George Handzo, who serves as a chaplain and director of health services research and quality for HCCN. The nonprofit is devoted to increasing the quality and integration of spiritual care in health care.

“These codes are a critical step in making spiritual care not only an important component of care given to beneficiaries, but also one that will be delivered with highly verifiable and replicable quality,” said Handzo in a letter to CMS. “Our recent request is to remove the VA restriction and make these codes accessible everywhere in health care in relation to the role and contributions of professional health care chaplains.”

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In its request, HCCN stated that in-depth assessments, consultations and counseling services provided by professional chaplains are a necessary part of an “integrated and comprehensive bio-psycho-social-spiritual approach” to assessing a patient’s needs, preferences and goals of care.

A formal ruling on the request is expected to come at the end of July or beginning of August. The participating organizations can resubmit their request after Jan. 1, 2022, if denied this time around. In a preliminary recommendation, CMS stated that it is “not aware of any claims-based need on the part of other insurers for reporting chaplain activity” and recommended maintaining the existing chaplain codes remain limited to Veterans Affairs use only.

Spiritual care is included in the comprehensive assessment of hospice patients conducted during the

first five days of hospice care. Hospices are required to provide an assessment of the patient and their family’s spiritual needs, provide counseling to address them, and make reasonable efforts to facilitate visits by local clergy, pastoral counselors or other qualified individuals.

In hospice, the chaplain is the only member of the interdisciplinary team that cannot report visits on the claim form, and this needs to change, stated Judi Lund Person, NHPCO’s vice president of regulatory and compliance, in a recent letter to CMS. This was the most recent in a series of requests to expand spiritual care coding.

While spiritual care falls under the bereavement assessment as part of the four core hospice services, providers currently have no way of tracking the volume or quality of these services. This puts them at a disadvantage when communicating the value of spiritual care to patients and payers, according to Lund Person.

“The biggest single benefit of this coding change is that hospices will be able to represent the full array of their services,” Lund Person told Hospice News. “If you’ve got chaplains doing a lot of visits and that’s a really important part of your services you provide, then you’ll know it if you have the data to back it. With approval of these codes, hospices are then able to really talk about the full range of services they provide.”

Tracking these services in greater depth would give providers the ability to gauge the amount of spiritual care patients receive and need. Establishing this barometer would support providers’ efforts to measure and improve quality, according to Handzo.

“This is about setting a standard for collecting the basic data of quantity and quality of chaplain services,” Handzo told Hospice News. “The codes are basically about establishing quantity, and then we can move from there to say we’re giving this much of the product. Once you start to know quantity, then you can start to drill down on quality. That’s what this is about to the beneficiaries, and that’s the message to CMS — that this is about providing the best bang for your buck.”

Chaplain codes also would allow hospices to gauge staffing needed to support those services amid workforce shortages plaguing the industry. Staffing shortages have worsened during COVID-19, with many hospice providers seeing a rise in turnover during the pandemic. A little more than 20% of health care workers have considered leaving the field, attributing their exodus to stress brought on by the pandemic, according to a recent study published in JAMA Network Open. About 30% have considered reducing their hours.

Employing the potentially expanded chaplain codes could be a key impact for hospices financially when it comes to reducing chaplain staff turnover and burnout, according to Parker.

“Utilizing these codes impacts an organization’s bottom line, which will significantly increase the reduction of staff turnover, burnout and compassion fatigue,” Parker said. “It should be the goal of every agency to utilize their hospice chaplains in a manner that’s fitting to the interdisciplinary team dynamics and the patient and family’s needs.”

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