- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Claim Reporting Requirements for Attending and Certifying Physicians
- 17729 Hospice Claim Edit for Certifying Physicians
- Billing Hospice Transfers
- Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Hospice Claim Submission Job Aid
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Canceling a Hospice Notice of Election
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Hospice Room and Board Denials
Medicare does not pay the room and board fees for hospice beneficiaries that reside in a SNF or a nursing facility (NF), as these charges are statutorily excluded from Medicare coverage. However, these charges may be paid by another insurer. If the patient has Medicaid, the state Medicaid agency may pay the hospice the daily amount allowed by the state for room and board while the patient is receiving hospice care, and the hospice would then pay the facility. Room and board services include:
- The performance of personal care services
- Assistance in activities of daily living
- Socializing activities
- Administration of medication
- Maintaining the cleanliness of a resident’s room, and
- Supervising and assisting in the use of DME and prescribed therapies
Some insurers require a room and board denial from Medicare before paying the hospice. Hospice providers may submit claims for the room and board charges in order to bill another insurer for these charges.
Billing
When a room and board denial is needed from Medicare in order to bill another insurer, providers should submit their covered hospice sequential claims as normal. The hospice should then submit a separate noncovered claim to Medicare that only includes the room and board charges, whenever possible. If it is not possible to submit a separate claim, the room and board charges can be submitted on the covered hospice sequential claim(s).
When submitting a claim for room and board charges only, in addition to the basic claim fields that are required for all hospice claims, the noncovered claim should include the following:
| Claim Page One | Description |
|---|---|
| TOB | Valid Values: 810 Freestanding hospice 820 Hospital-based hospice |
| STMT DATES FROM | Enter the same ‘from’ date that was reported on the covered sequential hospice claim |
| STMT DATES TO | Enter the same ‘to’ date that was reported on the covered sequential hospice claim |
| ADMIT DATE | Enter the date of the hospice election in the MMDDYY format |
| COND CODES | Valid Value: 21 |
| Claim Page Two | Description |
|---|---|
| REV | Valid Value: 0659 |
| HCPC | Valid Value: A9270 |
| MODIFS | Valid Value: GY |
| TOT UNIT | Enter the total number of days for the statement period |
| TOT CHARGE | Enter the room and board amount (the TOT CHARGE amount and the NCOV CHARGE amount should be the same) |
| NCOV CHARGE | Enter the room and board amount (the TOT CHARGE amount and the NCOV CHARGE amount should be the same) |
| SERV DT | Enter the same date that is entered in the STMT DATES FROM field |
| Claim Page Four | Description |
|---|---|
| REMARKS | Include remarks that explain the reason for the noncovered claim (e.g., “Room and Board denial request”) |
When submitting a claim with both covered charges and the noncovered room and board charges, in addition to the claim information that is required for the covered hospice claim, the claim should also include the following line item information for the room and board charges:
| Claim Page Two | Description |
|---|---|
| REV | Valid Value: 0659 |
| HCPC | Valid Value: A9270 |
| MODIFS | Valid Value: GY |
| TOT UNIT | Enter the number of days during the statement period that the room and board charges were applied |
| TOT CHARGE | Enter the room and board amount (the TOT CHARGE amount and the NCOV CHARGE amount should be the same) |
| NCOV CHARGE | Enter the room and board amount (the TOT CHARGE amount and the NCOV CHARGE amount should be the same) |
| SERV DT | Enter the first date that room and board charges were applied for the statement period |
| Claim Page Four | Description |
|---|---|
| REMARKS | Include remarks that explain the reason for the noncovered claim (e.g., “Room and Board denial request”) |
Revised 5/23/2024