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Printed Date: 9/22/2015
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:
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.
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:
Steps for the Receiving Hospice:
Steps for the Transferring/Discharging Hospice:
Note: When the transfer takes place on the same date between the two hospices, both hospices can be paid for that day.
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:
References: CMS Internet Only Manuals:
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Last Updated: 09/02/2020