- 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
Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, VBID Model, Participating MAOs
The Centers for Medicare & Medicaid Services issued Change Request 12524 which requires Medicare Administrative Contractors who process hospice claims to complete a mailing to hospice providers regarding the Value-Based Insurance Design model. This VBID model allows participating Medicare Advantage Organizations to offer the hospice benefit to Medicare beneficiaries enrolled in the MAO. A letter will be sent out no later than 1/31/2022 to all hospice providers explaining the VBID model and will include a listing of participating MAOs. This model began in 2021 and additional MAOs have been added in 2022.
In the past when a Medicare beneficiary covered by a MAO elected the hospice benefit, the beneficiary’s Medicare benefits would revert to Medicare Fee-for-Service for all services related to their terminal illness. Any services not related would continue to be the responsibility of the MAO. Beginning in January 2021 and continuing on in 2022, those MAOs participating in the model which allows the beneficiary’s coverage to remain with the MAO even if the beneficiary elects the hospice benefit. In the event a Medicare beneficiary revokes or is discharged from the hospice benefit, that beneficiary will remain enrolled in the MAO plan.
Information for Hospice Providers
CMS requires participating plans to communicate with hospice providers in its service area. CMS encourages hospice providers to communicate with participating plans regarding any questions about joining the plan’s network of hospice providers. For questions about enrollment, billing, claims and contracting related to enrollees of participating plans, hospice providers should contact the participating MAO. For questions about the Model, please contact CMS at VBID@cms.hhs.gov.
Top Three Things Hospice Providers Need to Know
- You must send all notices and claims to both the participating MAO and your MAC. The MAO will process payment, and the MAC will process the claims for informational and operational purposes and for CMS to monitor the Model.
- If you contract to provide hospice services with the plan, be sure to confirm billing and processing steps before the calendar year begins, as they may be different.
- Note: While we encourage you to reach out to participating MAOs about contracting opportunities, you are not required to contract. If you choose not to contract, the participating MAO must continue to pay you at least equivalent to Original Medicare rates for Medicare-covered hospice care.
- The Model does not permit prior authorization requirements around hospice elections or transitions between different levels of hospice care.
Attached are the instructions (R11160OTN) from CMS regarding this VBID model and below is a list of MAOs participating in the Model for CY 2022.
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| Returning Participants |
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Related Content
- Letter and checklist
- VBID Model Fact Sheet CY 2022
- Value-Based Insurance Design Model Hospice Benefit Component Calendar Year 2022 Monitoring Guidelines
- Medicare Advantage Value-Based Insurance Design Model Calendar Year 2022 Model Participation
- VBID Model Hospice Benefit Component Outreach & Education
- VBID Model Hospice Benefit Component Participating Plans
- VBID CY2022 Hospice Benefit Contact Information (XLS)
Revised 1/26/2022