Hospice Billing

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Hospice admission and utilization is under the watchful eye of the Medicare and Medicaid contactors, particularly in two areas:

• appropriateness of admission and
• length of stay for non-cancer diagnoses.

But often the external audit results are based upon technicalities that can be caught in pre-billing edits. The MJS Claim DNA program works with the hospice provider to reduce the risk by ensuring that technicalities are resolved before the claim is submitted. 

• Additional features of the MJS hospice billing include, but are not limited to, the following:
• Payor eligibility checked with demographic match-up
• 81A or 82A filed with respective payor
• Medicare/Medicaid coverage appropriateness in place at admission/recertification (LCD specific review)
• Election statement complete and meets all requirements
• Evidence of Attending Physician involvement in place, when selected
• Initial Physician Order includes all services and treatments with core member involvement
• CTI meets timeliness and is complete with all required elements including F2F attestation when required
• CTI narrative is written by the physician and meets acceptable compliance standards
• F2F timely completed by qualified NPP or physician with attestation present
• F2F precedes CTI physician date.
• Comprehensive assessment(s) completed within 5 days of admission
• Plan of Care (POC) is individualized and meets the content requirements as contained in MLN9895410_04_2024
• Changes in level of care are ordered by physician with IDT participation
• IDT meets timely with participation indicated
• POC updated at least q15 days, signed and dated by physician
• Hospice medications identified for inclusion in claims if required!
• Clinical notes for RHC, GIP, and CC services are present for each date of service billed.
• And much more as the industry changes.

 Don’t outsource to persons who do NOT know or checks for claim compliance before submitting the bill!