If you have been providing hospice care for a patient, it is important to understand how billing works. Hospice care is expensive and can be very confusing if you are not familiar with the process. In this blog post, we will cover what you need to know about hospice billing.
What Does Hospice Billing Involve?
The first thing that needs to be understood is where payments come from and who pays them. We will also go over the types of services covered by Medicare, Medicaid, or private insurance and discuss tips on maximizing reimbursement rates of each kind of payer!
Medicare Hospice Reimbursement
If you are a Medicare beneficiary, then hospice care may be paid for by the government. However, there are limitations on what is covered and who can receive it.
Medicaid Hospice Reimbursement
If you have Medicare and are eligible for Medicaid, then hospice care may be paid by the government through this program as well. However, there are limitations on what is covered and who can receive it.
Private Insurance Hospice Reimbursement
If you have private insurance or your employer provides benefits that cover part of hospice costs, this will likely pay for any expenses not covered by Medicare. You should still know which services are included in these plans to ensure that all parts of your loved one’s needs are being cared for.
What Is Covered By Private Insurances?
It depends on the plan type, but most long-term care at home (outpatient medical) visits with physicians will usually be covered.
Understanding the Billing Process
To understand the billing process, we would need to know whether they were in a long-term or short-term plan. Did they opt into an insurance payment design? What’s their clinical status? And how many days did they spend in hospice care during the month period that is being billed for?
Revenue Coding and Care Levels
Hospices must report an HCPCS Level II code with a level of care revenue code to identify the service location where that level of care was provided.
Are you claiming care rendered at multiple locations? Make sure to identify each location on the claim with a corresponding HCPCS Level II code. For example, routine home care may be provided for a portion of the billing period in your residence and another portion billed from time spent in an assisted living facility. In this case, you should report one revenue code with the HCPCS Level II code for all of your routine home care days in a residence. Suppose there were any additional services provided to residents during their stay at an assisted living facility (such as assistive equipment due to injury). In that case, another Revenue Code is required that corresponds with these charges.
To be reimbursed by Medicare or Medicaid according to each resident’s needs while they reside in both facilities simultaneously, ensure that both codes are listed on the claim form correctly so it will not get denied.
Understanding Hospice Billing
Hospice Care is expensive and can be very confusing if you are not familiar with the process. This blog post covered just the basics of what you need to know about hospice billing. For more information about hospice, billing click here to learn more.