Medicare_Claims_Processing_Manual / 304

Why This Topic Matters

Hospice billing is highly structured, and this guidance affects how claims are submitted, processed, and coordinated across Medicare payment systems. The article is relevant to organizations handling hospice claims and physician-related hospice billing under Medicare Part A and Part B.

Article Sections

1. Overview

   Introduces the hospice benefit context and the transmittal’s general scope. Summarizes the kinds of hospice eligibility, election, and attending-physician topics addressed in the manual update.

2. Notice of Election (NOE) - Form CMS-1450

   Covers the hospice election notice process and the form used to communicate that election. Describes the submission pathway and timing considerations for the notice.

3. Completing the Uniform (Institutional Provider) Bill (Form CMS-1450) for Hospice Election

   Describes required data elements for hospice election claims on the institutional provider bill. Includes field-by-field billing form completion guidance and related identifiers used on the claim.

4. Payment Rates

   Summarizes hospice payment-rate structure and annual publication of national rates. Addresses how payment components are adjusted at a general level and how the rate framework relates to hospice revenue reporting.

5. Data Required on Claim to FI

   Outlines claim submission requirements for hospice billing to the fiscal intermediary. Covers the claim form, bill structure, and the categories of claim data and status information used in hospice processing.

6. Administrative Activities

   Addresses physician administrative and supervisory activities within hospice operations. Discusses the role of hospice leadership and interdisciplinary-group participation in relation to payment coverage.

7. Patient Care Services

   Covers direct patient care services furnished in the hospice setting. Explains the general relationship among hospice employment status, payment source, and the attending physician role.

8. Attending Physician Services

   Discusses attending physician responsibilities and how hospice status affects physician-related billing. Also addresses coordination of hospice and non-hospice services and the use of Medicare claim modifiers in this context.

9. Care Plan Oversight

   Explains hospice-related care plan oversight billing at a high level. Covers claim submission expectations, timing, and the connection to hospice care coordination.

10. Carrier Processing of Claims for Hospice Beneficiaries

    Describes carrier processing rules for claims involving hospice beneficiaries. Focuses on how carrier systems are expected to recognize hospice enrollment and route claims for appropriate handling.