Claims From Medicare
Advantage Organizations
Federal regulations require that Medicare fee-for-service contractors maintain
payment responsibility for managed care enrollees who elect hospice. These
regulations are found that Medicare Fee for Service retains payment
responsibility for all hospice and non-hospice related claims beginning on the
date of the hospice election.
A - Covered Services
While a hospice election is in effect, certain types of claims may be submitted
by either a hospice provider, or a provider treating an illness not related to
the terminal condition, to a fee-for-service contractor of CMS. These claims
are subject to the usual Medicare rules of payment, but only for the following
services:
1. Hospice services covered under the Medicare hospice benefit if billed by a
Medicare hospice;
3. Services not related to the treatment of the terminal condition while the
beneficiary has elected hospice; or
4. Services furnished after the revocation or expiration of the enrollee’s
hospice election until the full monthly capitation payments begin again.
Monthly capitation payments will begin on the first day of the month after the
beneficiary has revoked their hospice election.
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