Home Health & Hospice Week

Get the dates straight for claims denials.

It may seem like 2022 just got going, but Medicare is already looking ahead to 2023 — and not just for VBP and OASIS-E.

The Centers for Medicare & Medicaid Services recently released a MLN Matters article, “Calendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model — Implementation,” that notes that “participating [Medicare Advantage Organizations] will include the current Medicare hospice benefit into MAO covered benefits in combination with offering palliative care services outside the hospice benefit for enrollees with serious illness and providing individualized transitional concurrent care services.”

MLN Matters article MM12688 specifies that “Medicare will deny payment for claims with dates of service during a hospice election (with a hospice election start date on or after January 1, 2021 through December 31, 2024) for services provided to a patient enrolled in an MA plan participating in the VBID Model’s Hospice Benefit Component.”

However: “This is ONLY applicable if the MA plan participated in the VBID Model’s Hospice Benefit Component from January 1, 2021 through December 31, 2024,” the article stresses.

For example, “if an MA plan only participates in the VBID Model’s Hospice Benefit Component from January 1, 2022-December 31, 2024, Medicare will deny payment for claims with dates of service during a hospice election (with a hospice election start date on or after January 1, 2022-December 31, 2024) for services provided to a patient enrolled in said plan,” the article offers.

See the article online at www.cms.gov/files/document/mm12688-calendar-year-2023-modificationsimprovements-value-based-insurance-design-vbid-model.pdf.