Hospice (64) Medical Billing Tips

The Hospice program provides home health and/or inpatient care, available 24 hours a day, which utilizes an interdisciplinary team of personnel trained to provide palliative and supportive services to a patient/family unit experiencing a life limiting disease with a terminal prognosis.

Special Billing Instructions
Providers are to use a single line item per Revenue code along with the total number of service units/hours for the calendar month for each client.

All Hospice claims are to be billed on a monthly basis. All claims should be submitted to First Health Services during the first week of the month following the month of service.

Covered Services
Physical therapy, occupational therapy, respiratory therapy and speech-language pathology are Medicaid covered benefits when they are provided for the purpose of symptom control, or to enable the patient to
maintain activities of daily living and basic functional skills.
Counseling services are available to both the individual and the family. Bereavement counseling for the client’s family and significant others is available for up to one year after the patient’s death.
Medicaid provides coverage for equipment provided by the hospice for use in the patient’s home pursuant to the Plan of Care (POC).

Services included in the hospice benefit plan are:
• Home health aide and homemaker services
• Nursing care and services
• Social services
• Palliative care
• Management of the terminal illness and related conditions
• Routine home care
• Continuous home care
• Inpatient respite care
• General inpatient care
Services unrelated to the terminal illness billed by non-hospice Providers may be covered
subject to the specific program's limitations.

Non-Covered Services
No reimbursement is provided for curative services.

Prior Authorization Requirements

Prior authorization is required for admission into a Hospice program. Prior authorization
is also required for all services unrelated to hospice diagnosis.

All required documentation must be received in order for DHCFP to issue a Billing Authorization Letter to the Provider.

It is essential to verify the recipient’s Medicaid eligibility each time a service is provided. In addition, hospice Providers must coordinate efforts with non-hospice Providers to ensure that prior authorization is obtained from First Health Services for all services not related to hospice benefits.

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