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Last Modified: 10/6/2021 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 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 traditional Medicare program. The information below provides a general guidance on how to submit claims.
When a beneficiary elects hospice during an inpatient stay:
Bill traditional Medicare for period before hospice election
Patient status code is 51 (discharge to hospice medical facility)
Discharge date is the effective date of hospice election
Bill hospice for period of care after hospice election
When a patient revokes hospice during an inpatient stay:
Bill hospice 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 article Reject reason code C7010.
Source: CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 9 external pdf file
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