Medicare HETS 270/271 - Information Bulletin - Value-Based Insurance Design (VBID) - December 21, 2020

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Medicare HETS 270/271 - Information Bulletin - Value-Based Insurance Design (VBID) - December 21, 2020
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HETS 270/271

Medicare HETS 270/271 Submitters:

Beginning on January 1, 2021, through the voluntary Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component, participating Medicare Advantage Organizations (MAOs) can include the Medicare hospice benefit in their benefits package.

Hospice providers can check a patient’s Medicare eligibility to verify that the patient is enrolled in a Medicare Advantage (MA) plan that’s participating in the Hospice Benefit Component of the Model by taking these 3 steps:

  1. Submit a HETS 270 eligibility request. If the patient is Medicare eligible, you’ll get a 271 response.
  2. Confirm the patient’s enrollment in an MA plan and the effective and termination dates of that enrollment.
  3. Compare the patient’s plan information to the list of participating plans.   If their plan is part of the Hospice Benefit Component of the Model, follow the directions for submitting claims on the Billing/Payment webpage.

Currently, when an MA enrollee elects hospice, Fee-for-Service Medicare becomes responsible for coverage and payment of most services while the MAO remains responsible for certain services (for example, supplemental benefits). Under this Model, the MAO is responsible for coverage and payment of all services, including all hospice care.

If a hospice provider is under contract with a participating MAO and provides care to an enrollee, the hospice must send all required notices and claims to its Medicare Administrative Contractor (MAC) and any contractually-required notices and claims to the participating MAO.

If a hospice provider isn’t under contract with a participating MAO and provides care to an enrollee of a participating plan, the hospice must send the same notices and claims to both the MAO and to the Medicare Administrative Contractor to get payment at Original Medicare rates.

For questions about enrollment, billing, claims, and contracting, contact the plan. Visit the Hospice Benefit Component webpage for more information on this Model.

Please contact the Help Desk if you have any questions.