Claim Denials During Hospice Elections Liability Reminder

When a Medicare beneficiary elects hospice benefits, the hospice is required to provide all items and services needed for the hospice treatment and palliative care associated with it in relation to the terminal illness and related conditions. 

Code of Federal Regulations 42CFR418.402 states that Medicare payment to the hospice discharges an individual’s liability for payment for all services, other than hospice coinsurance, that are considered hospice covered care.  

When electing hospice, the beneficiary waives their rights to Medicare payments for any services related to the treatment of the terminal illness and related palliative care. The exception to this is for the patient designated attending physician when they are not employed (or a volunteer) of the hospice. 

Hospices are required to submit a NOE within five days of the effective date of that election. Prompt filing of this notice is required to properly enforce the waiver and prevent inappropriate payments to nonhospice providers. 

It’s the responsibility of all Medicare-certified providers to check the Medicare status of each Medicare beneficiary when rendering and billing for services. If the patient is under hospice coverage, only the attending physician will be covered for services related to the hospice condition. 

Any provider that is not indicated on the NOE as the attending physician will not be paid separately for services and will be held liable for those services. That provider may not bill the beneficiary as it their responsibility to determine the patient status prior to providing care and billing for services. 

For additional information regarding this topic, please view our web page where we discuss this further at Professional Services During a Patient Hospice Election. Here you will find greater detail including the appropriate modifiers for billing services. 

Posted 10/3/2024