- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Annual Wellness Visits ‑ Billing Tips for Physicians
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
Background
CMS requires that a hospice physician or hospice nurse practitioner must have a FTF encounter with each hospice patient prior to the beginning of the patient’s third benefit period and prior to each subsequent benefit period. Failure to meet the FTF encounter requirements specified in CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section 20.1 results in a failure by the hospice agency to meet the patient’s recertification of terminal illness eligibility requirement, the patient would cease to be eligible for the benefit.
If the required FTF encounter is not timely, the hospice agency would be unable to recertify the patient as terminally ill, and the patient would then cease to be eligible for the Medicare hospice benefit. In such instances, the hospice agency must discharge the patient from the Medicare hospice benefit because he or she is no longer considered terminally ill as per Medicare regulations.
Where the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospice’s failure to meet the FTF requirement, CMS would expect the hospice agency to continue to care for the patient at its own expense until the required encounter occurs, enabling the hospice to re-establish Medicare eligibility.
Timeliness of the Face-to-Face
A timely FTF encounter occurs prior to, but no more than 30 calendar days prior to, the third benefit period recertification and every benefit period recertification thereafter. A FTF encounter may occur on the first day of the benefit period and still be considered timely.
Scenario
- The patient is in a third or later benefit period.
- A FTF was due on 9/26/20XX.
- The FTF was done but was not within the requirements to be timely. (Therefore, a timely FTF was not obtained for the certification period starting on 9/26/20XX).
- The next certification period start on 11/25/20XX.
- A timely FTF was completed for the benefit period starting on 11/25/20XX.
- The hospice agency noted that a timely FTF was not completed for the prior benefit period.
It is imperative to remember the Medicare regulations require that the patient be promptly discharged when the FTF is missed and may be readmitted once the FTF has been completed. In this scenario the hospice obtained the physician certification of terminal illness, and beneficiary election notice and fulfilled all other program requirements in order to admit the patient on 11/26/20XX when the error was noted.
Billing Considerations
The hospice will only be able to bill Medicare through 9/25/20XX, which is the last coverable day of the prior benefit period. The month of October is not billable to Medicare since the patient did not meet eligibility requirements. For the month of November, Medicare cannot be billed for any days prior to the new admission date of 11/26/20XX, when the FTF was completed and the patient was readmitted.
The use of occurrence code 77 is not appropriate when the FTF is late. Submitting an 8XB in this circumstance is not required. When the FTF is late, Medicare cannot be billed for days that the patient did not meet eligibility. Please follow the billing instructions below.
Instructions
- Submit a NOE for the new admission on 11/26/20XX. The NOE will RTP, however this will create a trail to show the NOE was submitted timely.
- Cancel the October claim.
- Adjust the September claim to indicate that it is a final claim and ends on 9/25/20XX.
- No claims will be submitted to Medicare during the time frame the beneficiary was ineligible for the Medicare hospice benefit.
- Once the FTF has been completed and the patient readmitted, resubmit the NOE to establish a new benefit period
- Once the NOE has processed and finalized the November claim for the new admission can be submitted.
Note: The claim(s) for the late NOE will have to be filed with coding for a late filed NOE with an exceptional circumstance. For additional instructions on a late filed NOE, visit the job aid, Notice of Election: Timely Filing of Hospice Elections.