05/10/2022

Correct Billing for Hospice Patients

When a patient is on hospice and they have an medicare advantage plan, they are no longer paying for service and telling us to bill medicare directly? If we do that , it will come back that they have other insurance? Hospice patient bill mediare is what they tell us. Please advise. Thank you

When a patient is enrolled in hospice, it has always been the protocol to bill regular Medicare part B so services not related to the patient’s terminal illness can be reimbursed. If a patient is enrolled in a Medicare advantage plan, such as Aetna, United Healthcare, Blue Cross, etc., they will not cover claims once a beneficiary elects hospice with Medicare. Any claims that are billed to Medicare once the patient elects hospice will be paid even if the patient has a Medicare Advantage plan. You should not expect a denial from Medicare for “coordination of benefits” or “claim not covered by this payer/contractor”. As long as the patient’s specific Medicare advantage plan was primary for the patient before electing hospice, traditional Medicare will be primary once the patient enrolls in hospice.