Which benefit, Medicare or Medicaid, is responsible for paying for the months of care provided to the beneficiary before the signed election statement was obtained?

Background:
A hospice patient has accessed their Medicaid benefits on admission to hospice. The patient was retroactively enrolled in Medicare and does not notify the hospice of their Medicare entitlement. The hospice did not have the beneficiary initially sign the election statement until the agency discovered that the beneficiary is entitled to Medicare.

Answer:
The Medicare hospice benefit cannot begin until the beneficiary signs the election statement. In cases where a beneficiary’s care begins prior to Medicare entitlement, a beneficiary must sign a Medicare Hospice election statement designating the effective date for Medicare hospice care to begin. The election statement cannot be back dated. Therefore, any care provided to a beneficiary prior to the date the actual election statement is signed is not billable to Medicare.

As a reminder, providers are responsible for ensuring that they check a patient’s Medicare eligibility upon admission and periodically throughout the time in which they are providing care.

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