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?
Code Service and Level of Care
Hospices must report an HCPCS Level II code with a level of care revenue code (651, 652, 655, and 656) to identify the service location where that level of care was provided. The following HCPCS Level II codes report the type of service location for hospice services:
Q5001 Hospice or home health care provided in patient’s home/residence
Q5002 Hospice or home health care provided in an assisted living facility
Q5003 Hospice care provided in a nursing long term care facility (LTC) or non-skilled nursing facility (NF)
Q5004 Hospice care provided in a skilled nursing facility (SNF)
Q5005 Hospice care provided in inpatient hospital
Q5006 Hospice care provided in an inpatient hospice facility
Q5007 Hospice care provided in a long term care facility
Q5008 Hospice care provided in inpatient psychiatric facility
Q5009 Hospice or home health care provided in place not otherwise specified (NOS)
Q5010 Hospice home care provided in a hospice facility
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 Q5001 and 651 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.
Identify the Type of Bill and Frequency
The hospice enters one of the following Types of Bill codes:
081x – Hospice (non-hospital based)
082x – Hospice (hospital-based)
The fourth digit, designated with the “x” above, reflects the “frequency definition” and is designated as one of the following:
- 0 – Nonpayment/Zero Claims: Use when no payment from Medicare is anticipated.
- 1 – Admit Through Discharge Claim: Use a bill encompassing an entire course of hospice treatment for which the provider expects payment (i.e., no further bills will be submitted for this patient).
- 2 – Interim – First Claim: Use for the first of an expected series of paying bills for a course of hospice treatment.
- 3 – Interim – Continuing Claim: Use when a bill for a course of hospice treatment has already been submitted, and further bills are expected to be submitted.
- 4 – Interim – Last Claim: Use for a bill that is the last of a series for a course of treatment. The “Through” date of this bill is the discharge date, transfer date, or date of death.
- 7 – Replacement of Prior Claim: Use to correct a previously submitted bill. Use this code on the corrected or “new” bill.
- 8 – Void/Cancel of a Prior Claim: Use to cancel a previously processed claim.
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.