- 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
Hospice Caps Job Aid
Disclaimer: This job aid is not a legal document and is a collaboration between CGS Administrators, LLC, National Government Services and Palmetto GBA.
Caps on Hospice Payments
Two caps affect Medicare payments under the hospice benefit:
- The Inpatient Day Limitation: The number of days of inpatient care furnished is limited to not more than 20 percent of total patient care days.
- The Aggregate Cap Limitation: Medicare reimbursement to a hospice is limited by their aggregate cap amount in each cap year. The aggregate cap amount is determined by multiplying the allowable Medicare beneficiary count by the statutory cap for the particular cap year.
Inpatient Day Limitation
Total for both general inpatient (0656) and inpatient respite care (0655) may not exceed 20% of the total Medicare days reported by the hospice for the cap year.
- If exceeded, adjustment is made to convert the excess inpatient nonrespite to routine care (651).
- Inpatient cap is calculated by the Medicare contractor after the end of the hospice’s cap year.
Aggregate Cap Limitation
Limits the total Medicare reimbursement amount by establishing a ceiling based on the statutory cap amount multiplied by the number of beneficiaries allowed in the cap period
- Statutory cap amounts are published in the Federal Register each year.
- Two methodologies for counting beneficiaries
- Streamlined Method (SL) – available only to those hospices that have elected to retain the SL method back in the 2012 cap year
- Proportional Method (PP) – Must be used by all other hospices
Self-Determined Hospice Cap Report
Hospices must make a self-reporting of their current cap position to their Medicare contractor no later than five months after the end of the cap year and must use data extracted no earlier than 90 days from cap year end and remit any overpayment due at that time.
- If hospices fail to file five months after the end of the cap year, payments are suspended.
Obtaining Necessary Reports
To assist hospices in preparing their SDHC reporting, hospices can obtain their PS&R summary and Hospice Beneficiary Count reports from the Centers for Medicare & Medicaid Services (CMS) website.