Specialized Hospice Billing Services
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Overview of Hospice Billing Services
Hospice care is specialized healthcare that is provided to terminally ill patients nearing the end of their lives. It aims to improve the quality of their lives through timely and extensive medical, social, emotional, and even spiritual support. Hospice care can be rendered at inpatient facilities or home.
Like most medical specialties, hospice care is covered by government and private insurance payers. Providers must complete the hospice billing process in an accurate and timely manner to collect payments for hospice services. Outsourced hospice billing and coding services ensure that providers get their rightful reimbursements without losing focus on quality patient care.
Common Challenges in Hospice Medical Billing
In certain circumstances, billing for hospice services is more complicated than billing for other medical procedures and services, particularly when palliative care is provided in a hospice setting, making a claim ‘not hospice appropriate'. Frequent and high claim denials can adversely affect the financial health of the hospice care center, directly impacting the quality of end-of-life care rendered to the patients.
Hospice billing staff must navigate the common pitfalls that can derail the insurance payment process, like coding complexities, late certifications and notice of elections, non-adherence to payer policies, and incomplete documentation, to prevent denials and the resulting revenue loss.
Lengthy Verifications
The patient eligibility and benefits verification process can be complex and time-consuming, especially for Medicare beneficiaries. This is because patients’ insurance coverages keep changing, and failing to verify eligibility and benefits at least 48 hours before admission can lead to payment rejections.
Late Referrals
Patients eligible for hospice care are often referred to hospices very late. Late referrals mean the patients cannot complete the allotted 90-day or 60-day periods for Medicare hospice benefits, and shorter stays complicate the billing process. Length of stays affects reimbursements for inpatient hospice care.
Inaccurate Coding
Billing for hospice services involves complex coding. Hospice care providers often have a hard time finding the most appropriate diagnoses (ICD-10), procedural (CPT), and equipment and supplies (HCPCS) codes and make mistakes when it comes to synchronization. The CPT and HCPCS codes don’t support ICD-10 diagnosis.
Changing Regulations
Frequent changes in government rules and regulations have a significant impact on hospice billing. For example, federal budget cuts lead to revised Medicare reimbursement rates for hospice care and stricter billing policies, making it difficult for providers to keep up and ensure compliance.
Outsource Hospice Billing Services to MediBill MD
Did you know that the burnout rate among hospice workers is one of the highest in the country? Studies funded by the National Institutes of Health (NIH) have shown that hospice and palliative care clinicians can experience a burnout rate of up to 62%, and the results for nonphysician clinicians (medical billers and coders included) are worse. From long working hours to staff shortages and emotional exhaustion to administrative workload, several factors contribute to this high burnout rate.
But when you outsource hospice billing to a professional company, like MediBill MD, it takes some load off the physicians and administrative staff and improves the operational efficiency and financial stability of the facility. Partner up for effortless hospice billing.
You get experience and expertise under one roof. At MediBill MD, we employ AAPC-certified professional coders, billing specialists, and revenue cycle managers who have a combined industry experience of over 20 years to ensure only the best of the best work on our clients’ accounts.
Single point of contact, from the beginning till the end. We assign a separate project manager to every client for effective and efficient communication, status monitoring, and real-time performance tracking. He thoroughly understands the needs of his clients and delegates or executes tasks accordingly.
Value-added hospice billing at industry-low rates. We charge a fraction of your total monthly collections for our proven hospice billing solutions. Plus, we only get paid when you do. With our unmatched pricing strategy, we ensure that you get the biggest returns on your small investment.
You get compliant and top-quality deliverables every time. We are 100% HIPAA-compliant and ISO-certified. Our processes are systematically designed to meet data security and the highest quality standards, safeguarding our clients from data leaks, heavy penalties, and lawsuits.
Lending a hand across the land! Whether you provide home hospice care in Hillsville, Virginia, or offer inpatient comfort care in New Orleans, Louisiana, we can guarantee prompt billing assistance with our nationwide reach and 24/7 virtual support. Our team expertly modifies the hospice billing process to adhere to your state’s regulations, ensuring seamless billing and payment collection for bottom-line success.
Overcome Hospice Billing Challenges with MediBill MD
Hospice providers may frequently encounter roadblocks in the intricate billing and coding process due to the changing regulations, coding guidelines, and payer policies. Moreover, the shortage of experienced hospice billing staff exacerbates the challenges as inefficient verification, missing documentation, coding confusion, and inaccurate claim submission trigger denials, causing the hospice to lose thousands of dollars in reimbursement revenue. Partner with MediBill MD to master the art of error-proof billing.
| Common Hospice Billing Challenges | MediBill MD Solution | |
|---|---|---|
| Failing to Submit the Notice of Elections (NOEs) to the Medicare Contractor Within 5 Days of Hospice Admission Date | We understand that timely submission of NOEs is a must to obtain Medicare reimbursements for hospice care given to Part A beneficiaries. We get the signed election statement from the patient pronto | |
| Failing to Document the Medical Necessity of Hospice Care(For example, records don’t clearly show that the patient has 6 months or less to live) | We maintain accurate and complete patient records, including test reports, clinical notes, referral letters, and prescriptions, to prove that the patient is terminally ill and requires end-of-life services. | |
| Billing Medicare or Private Insurers for Curative Care Requested by a Hospice Patient | Our hospice billing experts are aware that Medicare’s hospice coverage does not include payments for curative care. Hence, we don’t bill insurers for chemotherapies, antibiotics, or other treatments/therapies. | |
| Coding Confusion and Inaccuracies, Especially When Assigning ICD-10 and CPT Codes | Our AAPC-certified professional coders are aware that every CPT code must support the ICD-10 code. They ensure that the diagnosis and its resulting treatment are reflected in the code usage. | |
| Failing to Report Face-to-Face Encounters With the Hospice Patient When Obtaining Recertification for the 3rd Benefit Period | We submit complete documentation to Medicare to prove that a physician or nurse met the patient face-to-face and decided to extend hospice care to an unlimited number of 60-day periods. | |
| Failing to Communicate Patient Responsibility, i.e., 5% Coinsurance Amount for Palliative Drugs & Biologicals | We promptly and effectively notify Medicare beneficiaries that they are responsible for 5% of the cost of drugs or biologicals they were administered during hospice-related routine home care. | |
Lowest Prices Guaranteed
Unlock incredible savings with our impressive 1% promo rate! We offer comprehensive hospice billing services at industry-low rates to drive home the point that low cost does not always mean low quality.
Get In Touch with Our
Hospice Billing Experts
Talk to our experts and feel the MediBill MD difference as they supercharge your revenue cycle with unparalleled hospice billing services. Contact us for a free billing audit.
FAQs
At MediBill MD, we guarantee compliant, error-proof, and personalized hospice billing services at unparalleled rates. For introductory rates as low as 1% of your collections, you get 24/7 nationwide billing assistance, end-to-end revenue cycle management, and complimentary IT support to accelerate your facility's growth and financial success.
We only charge a small percentage of your net monthly collections for your full-scale hospice billing services. New clients can enjoy our promotional 1% rate for the first month of service, after which the pricing rolls back to the standard rates, 2-5% of the total monthly collection.
A hospice is a specialized medical care facility where patients with an anticipated life expectancy of 6 months or less receive treatment for their physical, emotional, and spiritual well-being. The aim of hospice care is to reduce the pain and suffering of terminally ill patients. In medical billing, hospice care is covered under Part A of Medicare.
One of the biggest challenges in hospice medical billing is accurate coding or translating diagnoses, treatment procedures, and equipment into standardized code sets. This is because every CPT or HCPCS code used must match the ICD-10 diagnosis to support the medical necessity of the procedure or the equipment. Moreover, these code sets are updated frequently, making it exceedingly hard for hospice care providers to keep up.
Hospice billing is a complicated and time-consuming process that requires precision to secure accurate and complete payments. The process begins with the verification of the patient’s insurance information, such as eligibility and benefits, involves charge capture, medical coding, claims submission, denial management, and A/R follow-up, and ends with payment posting.
Medicare beneficiaries receiving hospice care are covered under Part A. First, your facility must be Medicare-approved to bill Medicare for the services rendered to a hospice patient. Second, you must verify your patient’s Medicare insurance information, such as the member ID, contract number, and plan benefit package identification number. Finally, you must submit the Notice of Elections (NOE) and the completed claims form (CMS-1500 for physician billing and CMS-1450 for institutional billing) electronically to a Medicare Administrative Contractor (MAC) for processing. Claims must be filed within 12 months from the date of service.
The Medicare hospice benefit is for two initial 90-day periods and after that for unlimited 60-day periods until the patient’s demise, discharge, or change of provider. The hospice billing period lasts from the date of election to the date of termination.
No. Hospice care and palliative care are not billed the same way. Hospice care is completely covered by Medicare and includes comfort care for terminally ill patients nearing the end of their lives. In contrast, palliative care costs require copays, and the services can be delivered at any stage of the disease.
Yes. A Medicare-certified home health agency can bill Medicare for providing hospice care services to Medicare Part A beneficiaries in their homes. They must meet all the requirements set by Medicare for hospice billing to secure timely reimbursements.
