Hospice Billing

Billing Hospice Transfers

Once a beneficiary elects to receive care under the Medicare hospice benefit, he or she waives rights to Medicare payments for hospice care provided by any other hospice other than the one they have chosen/designated. However, a beneficiary can change hospices once per 90-day or 60-day benefit period. 

When the beneficiary chooses to change hospice providers, each hospice is permitted to bill for the day of transfer, and each will be reimbursed at the appropriate level of care for its respective day of discharge or admission. There can be no gap in service days for the benefit period in which the transfer takes place. No gap in service days also means no gap in billing – for claim purposes this means the “From” date for the receiving hospice must be the same as the “Through” date for the transferring hospice. The transferring hospice will submit their transfer claim with the appropriate discharge status code (50 or 51), and then the admitting hospice submits a transfer notice after the transfer has occurred. The transfer notice (the 8XC billing) does not get submitted until after the transferring provider has finalized their billing. This change of hospices continues the beneficiary’s current benefit period. 

To change the designation of the hospice, an individual or representative must file a statement or transfer agreement that includes the following information:

  1. The name of the hospice from which the individual has received care and the name of the hospice from which he or she plans to receive care; and
  2. The date the change is to be effective.
  3. The signature of the beneficiary or their representative.

Note: The signed statement or transfer agreement must be filed with both the transferring and receiving agencies.

Transferring Agency Billing

The hospice that the patient is transferring from must submit their final claim before the receiving agency can submit their notice of change/transfer. Since this is not a discharge from the hospice benefit but rather a transfer to another agency, do NOT include an occurrence code 42. The occurrence code 42 discharges the patient from the hospice benefit in the Common Working File.

In addition to the basic claim information that is required on all claims, the final claim must include the following:

Claim Page One

Field Description/Valid Value

TOB
Type of Bill


 Valid Values:
  • 811 – Freestanding hospice: admit through discharge claim
  • 821 – Hospital-based hospice: admit through discharge claim
  • 814 – Freestanding hospice: final interim claim
  • 824 – Hospital-based hospice: final interim claim
STAT
Patient Status		 Valid Values:
  • 50 – Discharged/Transferred to Hospice - home
  • 51 – Discharged/Transferred to Hospice - medical facility

 

Do not include an occurrence code 42 as this would discharge the patient from the hospice benefit.

Claim Page Four

Field Description/Valid Value
REMARKS Enter remarks explaining the transfer including the name, address, and provider number (if available) of the agency the patient is transferring to along with the effective date of the transfer.

 

Receiving Agency Billing 

The hospice the patient is transferring to submits a change of provider/transfer notice (8xC) prior to submitting claims for payment. The 8xC prompts transmission of the information to the CWF indicating that the admission to the receiving agency is a continuation of the current benefit period. The CWF maintains the beneficiary with the new hospice until death or until an election termination is received.

The 8xC must be submitted after the transferring hospice agency has submitted their final claim. All hospice claims/notices must be submitted and processed in sequence to maintain the integrity of hospice election periods. Communication between the two agencies is extremely important. The discharging agency should contact the receiving agency to let them know when the discharge claim is processed. The receiving agency can also check the CWF to determine if the discharge claim has been processed by looking at the DOLBA DATE in the hospice record. 

There are times when an agency may not work with the other agency. We ask that agencies always try to work it out between themselves. Make sure to document all contact attempts. If all attempts to work out the billing with the other agency fail, call the Provider Contact Center to assist with the transfer dispute.

The 8xC is an abbreviated claim; therefore, only a few fields are required, and there is no payment applied to this type of billing. 

Claim Page One

Field Description/Valid Values
MBI
Medicare Beneficiary Identifier		 Enter the beneficiary’s Medicare number.
TOB
Type of Bill		 Valid Values:
  • 81C (Freestanding hospice)
  • 82C (Hospital-based hospice)
NPI
​​​​​​​National Provider Identifier		 Enter the NPI associated with the provider number.
STMT DATES FROM Enter the date of the hospice transfer in the MMDDYY format.
PATIENT DATA Enter the beneficiary’s last name, first name, date of birth (MMDDYYYY), full mailing address, ZIP Code and gender.
ADMIT DATE Enter the date of the hospice transfer in the MMDDYY format. (Note:  the ADMIT DATE and STMT DATES FROM date should match.)
OCC CDS/DATE
Occurrence Codes and corresponding date		 Enter occurrence code 27 along with the date of certification in MMDDYY format. Note: occ 27 is only required on the transfer if the date of transfer is also the first day of the next benefit period.
FAC. ZIP Enter the facility ZIP Code of the provider (nine-digit code).

 

Claim Page Three

Field Description/Valid Values
CD
Payer Code		 “Z” is the proper code for Medicare. If system generated, do not change. 8xCs should be submitted with Medicare as the primary payer.
PAYER Enter “Medicare” if not system generated.
RI
Release of Information		 Enter the release of information indicator. Valid values are:
  • “Y” – yes, provider has a signed statement permitting release of information.
  • “I” – informed consent to release medical information for condition or diagnoses regulated by Federal Statutes
PRINICIPAL DIAGNOSIS CODE Enter the ICD code for the principal diagnosis. The code must be the full ICD diagnosis code, including all seven digits for ICD-10.
ATTENDING PHYS NPI/LN/FN Enter the NPI and the name of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient’s medical care.
OTHER PHYS NPI/LN/FN (Situational) Enter he NPI and name of the hospice physician responsible for certifying that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its normal course. Note: Both the attending physician and other physician fields should be completed unless the patient’s designated attending physician is the same as the physician certifying the terminal illness. When the attending physician is also the physician certifying the terminal illness, only the attending physician is required to be reported.

Note: For electronic claims using version 5010 or later, this information is reported in Loop ID 2310F – Referring Provider Name.

 

Claim Page Four

Field Description/Valid Values
REMARKS Enter remarks explaining the transfer including the name, address, and provider number (if applicable) of the agency the patient is transferring from along with the effective date of the transfer.

 

Related Content

Posted 7/17/2024