Hospice Billing: What You Need to Know

Hospice billing can be a complex and sometimes confusing process. It’s not something every healthcare practice encounters, but understanding the nuances is crucial when it does. I want to shed some light on hospice billing in this blog post. Please remember that I’m not a certified biller or coder, so that I won’t provide specific billing advice. Instead, I highlight key topics you should investigate further if hospice billing applies to your practice.

Understanding Hospice Billing

First and foremost, let’s clarify what we mean by hospice billing. When discussing hospice billing, we’re not referring to billing for hospice services. Instead, we’re discussing billing for patients who are enrolled in hospice. Patients are typically enrolled in hospice for specific diagnoses and reasons.

Billing for Services Related to Hospice

Any healthcare service or visit related to why a patient is on hospice should be billed to hospice insurance or the equivalent insurance for hospice care. For example, suppose a patient is on hospice for congestive heart failure and requires treatment for an unrelated issue like a urinary tract infection (UTI). In that case, you should bill the UTI services separately. These non-hospice-related claims should be billed to the patient’s primary insurance, like Medicare Part B, a Part C plan (if applicable), or a Supplement Plan.

Using the Right Modifiers

To ensure proper billing, you must use the appropriate modifiers. Modifiers indicate whether a service is related to the patient’s hospice condition. If you need help determining which modifiers to use, look them up. Using the correct modifier is crucial for claims to go to the right payer, especially when dealing with Medicare.

Understanding Where Claims Need to Go

Medicare covers most patients in hospice. If the services relate to the hospice diagnosis, the claims should be sent directly to Medicare. However, if the services are unrelated to the hospice reason for admission, they should be billed to the patient’s other insurance. It can get tricky, especially when dealing with patients on Medicare Advantage plans, like Blue Cross Blue Shield Advantage or AARP Advantage.

The Importance of Internal Billing and Coding

For practices that frequently see patients in hospice, having an internal biller and coder who understands this process is essential. Numerous claims get rejected or denied because of billing errors or incorrect submissions. Timely and accurate billing is vital to prevent unnecessary delays in receiving payment.

Challenges in Long-Term Care Facilities

One area where hospice billing can become even more challenging is providing care in long-term care facilities. It can be difficult to determine why a patient is on hospice, especially if there needs to be more communication between the facility and your practice. Establishing effective workflows and communication protocols can help avoid these issues.

Hospice billing is a complex process, and understanding the intricacies is essential for healthcare providers who frequently encounter patients in hospice. While this blog post provides a high-level overview, consulting with a certified biller or coder for specific guidance is important. Proper billing practices can significantly impact your practice’s revenue and the speed at which you receive payments. By investing in a solid internal workflow and communication system, you can minimize errors and ensure a smoother billing process. If you have questions or comments, feel free to leave them below. And if you found this information helpful, remember to like and subscribe for more insights in the future. Thank you for reading, and take care!