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Last Modified: 11/22/2022 Location: FL, PR, USVI Business: Part A

Claims overlap FAQ -- Hospice overlaps inpatient stay

Q: How do I bill my claims when a patient revokes or elects hospice coverage during his/her inpatient stay?
A: Electing or revoking the Medicare hospice benefit is the beneficiary’s choice. The patient or their representative may elect or revoke Medicare hospice care at any time in writing. The hospice entity cannot revoke the beneficiary’s election, nor request or demand that the patient revoke their election. If the patient revokes their hospice election, Medicare coverage of all benefits waived when hospice care was initially elected resumes under the original Medicare program.

Claim submittal for patients involving hospice election

When a beneficiary elects hospice during an inpatient stay:
Bill traditional Medicare for the period before hospice election
Patient status code is 51 (discharge to hospice medical facility)
Discharge date is the effective date of hospice election
Bill the hospice entity for the period of care after hospice election
When a patient revokes hospice election during an inpatient stay:
Bill the hospice entity for period up to hospice revocation
Bill traditional Medicare for period after hospice revocation
Admission date is same as the hospice revocation date
Statement 'From' date is the same as the hospice revocation date
For additional information review our FAQ on Reject reason code C7010.
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