decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2003 / AB-03-049
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Article Overview
This article explains a CMS program memorandum on hospice payment responsibility, coverage, and claims processing for Medicare fee-for-service contractors in situations involving managed care enrollment. It is relevant to hospital and physician billing staff, hospice organizations, and Medicare contractors who need to understand the broad regulatory framework, filing considerations, and associated operational guidance discussed in the memo.
Why This Topic Matters
It helps readers identify which Medicare contractor is responsible for processing certain hospice-related claims and understand the general filing and billing context addressed by the memorandum.
Article Sections
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Program Memorandum and Change Request Overview
Introduces the memorandum, identifies the issuing organizations, and notes that it reissues earlier guidance with limited changes.
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Purpose and Scope
Summarizes the policy area addressed by the memorandum and the regulatory setting referenced for hospice coverage and payment responsibility.
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Covered Services
Describes the broad categories of hospice-related and non-hospice-related services that may be submitted under the guidance when hospice election is in effect or has ended.
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Billing of Covered Services
Outlines the general billing pathways discussed for hospices, physicians, and intermediaries/carriers, including references to related transmittals and processing considerations.
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Timely Filing
Addresses filing timeframes and the circumstances under which exceptions may be considered for the claims discussed in the memorandum.
What You Will Learn
- The overall policy context for hospice claims when a beneficiary is enrolled in managed care
- Which organizations and contractor types are involved in the guidance
- The general categories of services discussed as covered under the memorandum
- The filing and implementation context referenced in the memo
Who Should Read This
- Medicare contractors
- Hospice billing staff
- Physician billing staff
- Revenue cycle and claims processing personnel
- Healthcare compliance professionals
Codes Discussed
Modifiers Discussed
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