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;
2. Services of the enrollee’s attending physician if the physician is not
employed by or under contract to the enrollee’s hospice;
