Home Health & Hospice Week

Find out more details about how the Value-Based Insurance Design Model’s Hospice Benefit Component works in a new frequently asked question set.

For example: “How a hospice provider bills depends on whether the hospice provider has a contract with the [Medicare Advantage] plan participating in the Model,” the Centers for Medicare & Medicaid Services explains. “If a hospice provider has a contract, that hospice provider must follow the requirements for billing and payment agreed to in its contract with the participating MA plan.”

On the other hand, “if a hospice provider does not have a contract (otherwise known as an ‘out-of-network’ hospice provider), then the hospice provider can bill the participating MA plan in the same way that it bills its Medicare Administrative Contractor (MAC) for hospice care,” according to the FAQs.

Another one: When it comes to Notices of Election, “the hospice provider must submit the NOE within five days of hospice election to its MAC and should submit the NOE within five days of hospice election to the hospice enrollee’s MA plan, unless the MA plan has communicated a longer timeframe for NOE timely submission requirements,” CMS explains.

And each MA plan may have its own “policies and procedures for accepting NOEs,” CMS adds in another FAQ.

See the 17-page, 58-FAQ set at https://innovation.cms.gov/media/document/vbid-hospice-2021-faqs.