- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Notice of Election Termination/Revocation
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Tips to Facilitate the Change of Ownership Process
- Service Intensity Add-on Payment
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Appeal for Claims Rejected for an Untimely Hospice Notice of Election
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Correcting Hospice Claims Sequentially to Avoid Reason Code U5181
- Common Working File System Edit F5052 and M5052
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Filing an Electronic Notice of Termination-Revocation of Election (Type of Bill 8XB)
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Notice of Election: Timely Filing of Hospice Elections
- Hospice Claim Submission Job Aid
- Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, VBID Model, Participating MAOs
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Hospice Prescription Drug and Infusion Pump Reporting
- Hospice Caps Job Aid
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Appropriate Use of Condition Code 85
- How to Correct/Avoid Reason Code U5150
- General Inpatient Check Off List
- Hospice Transfers Job Aid
- Medicare Two Tier Routine Home Care Payment Rate
- Canceling a Hospice Notice of Election
- Hospice Pricer Tool Quick Reference Tool
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
- Hospice Payment Rates
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
To facilitate more accurate billing of Medicare hospice claims, CMS is implementing several edits within the claims processing system to RTP, claims submitted on TOB 81X or 82X for which hospice days are billed for services provided in noncovered settings. CMS Change Request 6778, dated 2/5/2010, announced edits and appropriate place of service for GIP and CHC levels of care.
Medicare covers two levels of service, GIP and CHC, for hospice patients who require care beyond routine care during a crisis period. The focus of CHC is to provide predominately nursing care in response to a patient crisis, i.e., pain management, and allow the beneficiary to stay in the “home” setting. GIP care is a level or intensity of services in response to a crisis situation i.e., pain management, to provide care that can not feasibly be provided in any other setting, other than an inpatient setting.
Continuous Home Care
The focus of CHC is to provide a “skilled” level of nursing services yet allow the beneficiary to remain in the home setting. Therefore it would not be appropriate to provide this level of service in the following settings:
- Q5004 - Skilled nursing facility
- Q5005 - Inpatient hospital
- Q5006 - Inpatient hospice
- Q5007 - Long-term care hospital
- Q5008 - Inpatient psychiatric facility
These types of facilities typically are required to have nursing staff available to perform at a higher level of service, care that would not be found in a patients home. If a beneficiary resides in this type of facility a CHC level of service would not be appropriate due to the requirements of the facility to provide a higher level of care if the patient’s condition warrants it.
General Inpatient Care
The focus of GIP is to provide an intensity of service in response to a patient crisis situation that can not feasibly be provided in any other setting. A GIP level of service typically requires frequent monitoring of a patient, and/or medication or interventions by a physician or nurse. Therefore it would not be appropriate to bill a GIP level of service in the following settings:
- Q5001 - Patients home/residence
- Q5002 - Assisted living facility
- Q5003 - Nursing long-term care facility of non-skilled nursing facility
These types of facilities typically are not required to provide “skilled care” as part of the room and board, and often do not meet the staffing requirements for a GIP level of care. The CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Section 30.1, Levels of Care Data Required on the Institutional Claim to Medicare Contractor, (428 KB) states: “Payment at the inpatient rate is made when general inpatient care is provided at a Medicare certified hospice facility, hospital, or skilled nursing facility.” Therefore it would not be appropriate to provide a GIP level of care in a non-SNF. However, some nursing facilities are dually certified as a SNF and NF. In this instance when the beneficiary requires a GIP level of care and all COPs are met as a SNF, and the SNF is providing these services the hospice provider could bill for a GIP level of care.