decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / AB-02-015
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Article Overview
This Program Memorandum explains Medicare payment responsibility and claims processing for hospice-related services when beneficiaries are enrolled in managed care. It is aimed at Medicare contractors and related billing staff who need to understand the scope of covered services, billing pathways, timely filing considerations, and the CMS and regulatory references that govern these claims.
Why This Topic Matters
It helps contractors and billing teams recognize which hospice-related claims remain payable under fee-for-service arrangements and how CMS expects those claims to be processed. The memo is relevant for avoiding payment disruptions and for understanding the interaction between hospice election, managed care enrollment, and Medicare claims workflow.
Article Sections
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Purpose and Scope
Introduces the memorandum’s focus and the regulatory background it addresses. Also identifies the CMS and Medicare framework relevant to hospice payment responsibility.
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Covered Services
Outlines the general categories of hospice-related and non-hospice-related services discussed in the memorandum. Describes which claim situations fall within the scope of the guidance.
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Billing of Covered Services
Summarizes the billing pathways discussed for different provider types and claim handling processes. Includes references to claims submission procedures and related CMS system processing.
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Timely Filing
Addresses the filing-time framework for claims discussed in the memorandum. Notes the applicability of case-by-case exception handling under CMS guidance.
What You Will Learn
- How CMS frames payment responsibility for hospice-related services in managed care contexts
- What general categories of services are addressed by the memorandum
- Which organizations and regulatory sources are referenced in the guidance
- What timing considerations apply to the claims processing discussion
Who Should Read This
- Medicare fee-for-service contractors
- Medicare carriers and intermediaries
- Hospice billing staff
- Managed care organization billing staff
- Medical coders and revenue cycle staff
Codes Discussed
Modifiers Discussed
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