Hospice Transfer Requirements

The admission process is one of the most important steps in Hospice Billing. Upon admission, providers are required to verify the beneficiary’s eligibility files to ensure the patient is entitled to Medicare and determine if prior hospice benefit periods exist.

An individual may change, once in each election/benefit period the designation of the particular hospice from which he or she elects to receive hospice care. The change of the designated hospice is not considered a revocation of the election, but is a transfer. When a patient has been discharged or revoked from the hospice Medicare benefit, readmission cannot occur on the same day. It is imperative that hospices work together when a patient chooses to change hospices.

To ensure proper billing and avoid overlapping situations where a transfer takes place, hospices should view the beneficiary’s eligibility records in the Health Insurance Query Access (HIQA) in the Direct Data Entry (DDE) system or through Palmetto GBA's eServices online provider portal by selecting the ‘Eligibility’ tab. To access the beneficiary’s eligibility records:

  • HIQA
    • Type ‘HIQA’ on the main screen after logging into the Direct Data Entry (DDE) system using the appropriate user name and password.
    • Fill in the appropriate beneficiary information required on the first screen and hit ENTER. The start of care date may be entered in the APP FIELD to better filter the data
    • The system will return the four most recent benefit periods (if any) on pages two and three (if applicable).
  • eServices – Eligibility Check:
    • After signing in to the system, select the ‘Eligibility’ tab, and enter the beneficiary’s name, Medicare number, etc. and a date range.
    • When the beneficiary’s Medicare eligibility screen displays, select the ‘Hospice/Home Health’ option.
    • The system will return the two most recent benefit periods (if any) within 12 months of the start of care date.
  • It is recommended that either pages two and three (if applicable) of HIQA or the eServices eligibility check page be printed and placed in the patient’s record. Should a situation arise regarding a billing conflict, this information may be requested by Palmetto GBA.
  • The table below provides the information you will need to determine how to proceed based on the information available in the beneficiary’s eligibility records.

Situation
Yes
No
Action
Prior hospice benefit period(s) found?
X
 
Verify the revocation indicator and make note of the Provider Transaction Access Number (PTAN) and NPI of any other agencies found.
 
X
Ask the beneficiary or authorized representative if hospice care has been provided at any time in the past. If not, then proceed with the admissions process.
Prior benefit period(s) found, and revocation indicator is ‘1’ or ‘2’?
X
 

This indicates that the beneficiary has been discharged or revoked from the Medicare Hospice Benefit. Proceed with normal admission process.

*Note: Be sure to verify the end date of the existing benefit period. A new benefit period cannot begin on the same date as the end date of an existing benefit period.

 
X
Verify that a transfer has not already taken place within the existing benefit period.
Beneficiary-elected Transfer has already taken place between two agencies during the election/benefit period?
X
 
Inform the beneficiary that he or she is not eligible to transfer to another agency until the beginning of the next election/benefit period.
 
X
Proceed with the transfer process.

Transfer Requirements:
Either the transferring/discharging or receiving hospice may assist the patient/authorized representative with initiating the transfer. In either case, the following requirements must be met:

  1. Contact must be made with the other hospice agency and the following must be documented:
    • The method of the communication (e.g., email, telephone, fax)
    • Date/time of the contact with the other agency
    • The name individual with whom you communicated at the agency
    • **Note: Unanswered communications are not acceptable. Ensure that you document the response from the other agency to ensure both hospices are in agreement with the terms of the transfer.
  2. The transfer date must be agreed upon before the transfer takes place. The transfer date must either be the same day or the day after the patient leaves one hospice and received by the other hospice.
  3. There cannot be a gap in days. If there is a gap in days between the transferring/discharging and receiving hospice, then a discharge from and readmit to the Medicare Hospice Benefit will have to take place.
  4. Explain to the beneficiary or the authorized representative that he or she is required to sign and date the transfer agreement form (hospices have the flexibility to design and create their own forms, but only one form is required). The transfer form must also include the following:
    • The name of the hospice from which the individual has received care,
    • The name of the hospice from which they plan to receive care, and
    • The date the change is to be effective.
  5. Ensure that a copy of the transfer agreement form is on file with both agencies before the transfer takes place.

Steps for the Receiving Hospice:

  1. Document in the record that you accessed the patient’s eligibility records in HIQA by printing pages two and three (if applicable) or the Hospice/Home Health screen in eServices.
  2. Contact the existing hospice agency to work out the transfer date if you are assisting the patient/authorized representative with initiating the transfer.
  3. Complete all assessments required by the hospice conditions of participation as described in the Code of Federal Regulations, 42 CFR 418.54.
  4. If the beneficiary is transferring hospices in the third or later benefit period, a face-to-face encounter is not required if the receiving hospice can verify that the originating hospice had the encounter.
  5. A change of ownership of a hospice is not considered a change in the patient’s designation of a hospice and requires no action on the patient’s part. See the Hospice Change of Ownership job aid and Hospice Billing the 8XE Job Aid for more information.
  6. Ensure that all transfer requirements listed above have been met.
  7. Ensure that the transferring/discharging hospice has already submitted their final claim (8X1 or 8X4), and then submit the Notice of Change (8XC) to Medicare.
  8. After the Notice of Change (8XC) is processed, subsequent claims may then be submitted.

Steps for the Transferring/Discharging Hospice:

  1. Contact the receiving hospice if you are assisting the patient/authorized representative with initiating the transfer, and document the information outlined above in the transfer requirements section.
  2. Submit your final claim (8X1 or 8X4) with Patient Status Code 50 or 51 to indicate transfer to another hospice.
  3. Ensure the dates of service on the claim are correct and align with the transfer date.

Note: When the transfer takes place on the same date between the two hospices, both hospices can be paid for that day.

  • Example: Beneficiary elects to transfer on 08/05, which is the same day he or she leaves transferring agency and is admitted to the receiving agency.
  • The transferring/discharging hospice submits their final claim (8X4) with dates of service 08/01 through 08/05 and a patient status code of 50 or 51.
  • Receiving hospice submits their Notice of Change (8XC) with 08/05 as their ‘Admit’ and ‘From’ date. The date reported with occurrence code 27 is the start date of the benefit period in which the patient transferred.
    • Once the 8XC is processed, the claim for dates of service 08/05 to 08/31 (assuming the patient is still on service at the end of the month) may be submitted.
  • Both agencies will be paid for 08/05 at the level of care they provided.

Geographical Location Transfers
Some beneficiaries or authorized representatives choose to change hospices from one geographical location to another. When this happens, hospices often question payment responsibility for certain services that may be needed during the time the beneficiary is traveling from one area to another. Before the change of hospice takes place, both hospices should:

  1. Work together to determine payment responsibility if ambulance transport is needed.
  2. Assess the following:

Situation
Yes
No
Action
Determine the length of time it will take for the beneficiary to travel from one location to another. Is the length of time short enough in duration such that one or both hospices could provide care if necessary?
X
 
Both hospices should coordinate with each other to determine which hospice will provide any care that may be necessary.
 
X
Determining whether or not the beneficiary will be traveling through a geographical location in which one or both hospices is authorized to provide care if necessary. If so, then the beneficiary may need to be discharged from the existing agency and readmitted by the receiving agency at a later date.  If not, and one or the other or both hospices can provide care, then proceed with the transfer process.
Will the beneficiary be traveling through any geographical location in which one or both hospices have the authority to provide care if necessary?
X
 
Both hospices should coordinate with each other to determine which hospice will provide any care that is necessary.
 
X
Determine if the beneficiary will be traveling through a geographical area in which neither hospice has the authority to provide care. If not, then proceed with the transfer process.
Will the beneficiary potentially need care in a geographical location in which neither hospice as the authority to provide care?
X
 
The beneficiary may need to be discharged from the hospice Medicare benefit and the readmitted by the receiving agency at a later date after arriving at his/her destination. The readmission cannot occur any earlier than the day after the beneficiary is discharged from the hospice Medicare benefit. 
 
X
Proceed with the transfer process.

References: CMS Internet Only Manuals:

  • Publication 100-02, Chapter 9, Section 20.2.1
  • Publication 100-04, Chapter 11, Sections 20.1.2, 30.3 and 90

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