Billing Software Duplicate Hospice Notices and Claims
The Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component requires billing software capability to send duplicate notices and claims to both the participating Medicare Advantage Organization (MAO) and Medicare Fee-for-Service (FFS) Medicare Administrative Contractor (MAC). Under this model the MAO will process payment, and the MAC will process the claims for informational, operational, and CMS monitoring purposes.
Even if the hospice provider doesn’t contract with the MAO, the hospice provider must submit duplicate notices and claims to the MAO and MAC for patients enrolled in participating MAO plans. The MAO will pay the non-contract hospice at Original Medicare rates for Medicare-covered hospice care.
Beginning on January 1, 2021, participating MAOs could include the Medicare hospice benefit in their benefits package through the voluntary VBID model. In calendar year 2023, the Hospice Benefit Component expands to 15 MAOs in 23 states and Puerto Rico.
Hospice providers can confirm a patient’s Medicare eligibility and check for Medicare Advantage (MA) enrollment by taking these 3 steps:
1. If your patient shows you an MA enrollment card, move to Step 2. If your patient shows you a Medicare card with a Medicare Beneficiary Identifier, use either your normal process or any of the following online tools or services to check for MA enrollment:
- MAC Portal
- MAC Interactive Voice Response (IVR) System
- Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)
- Billing agencies, clearinghouses or software vendors
2. If the patient is in an MA plan, identify the MA contract number and plan benefit package identification information on the MA enrollment card or by using one of the online tools or services in Step 1.
- It will look like this: H#######. For example, H1234-001
- Reminder: Check the effective and termination dates to ensure the patient’s enrollment in the participating plan is for 2023.
3. Compare the information from Step 2 with the list of participating plans’ information available on the model website at https://bit.ly/VBIDhospice or available to directly download at https://bit.ly/2023HospiceMAOs. If their plan is part of the Hospice Benefit Component of the model, follow the directions for submitting claims on the Billing/Payment webpage.
Please contact the Help Desk if you have any questions.