Eli's Hospice Insider

Published on Tue Jan 25, 2011 PDF

You must educate patients on what is covered by each program.

If you've been wondering how to bill for your hospice patients when they enter VA facilities, you're not alone. "Cahaba has recently received questions, and requests for clarification, regarding Medicare beneficiaries who are eligible for both Veterans Administration (VA) and Medicare benefits, and are considering hospice care," regional home health intermediary Cahaba GBA says in its January newsletter for providers.

Official word: "If a duly eligible veteran, who had been receiving Medicare hospice services in his/her home, is admitted to a VA owned and operated inpatientfacility, the beneficiary must revoke the Medicare hospice benefit," according to the Medicare Benefit Policy Manual. "Medicare is not allowed to pay for those services for which another federal entity is primary payer," it says.

"Dually eligible veterans may elect to receive Medicare hospice services while residing in community nursing homes and state homes and have those services paid for under the Medicare hospice benefit, with the exception of room and board, which is not covered by Medicare," Cahaba explains in the Newsline article.

Bottom line: "Hospices who are discussing the Medicare hospice benefit with a beneficiary who is also eligible for VA benefits should educate the beneficiary on what is covered by which program," Cahaba advises. "It is up to the beneficiary to choose the program from which they would like to receive benefits."

If benes want to elect VA benefits later, they'll have to revoke the hospice benefit, Cahaba explains.

Don't forget: "If the beneficiary chooses the MedicareHospice Benefit over VA benefits, you must bill the claim conditionally to Medicare (using Process G on the Medicare Secondary Payer [MSP] Billing & Adjustments quick reference tool) and include a note in Remarks on FISS claim Page 4 (FL80 for paper billers) that the patient opted not to use their VA benefits for the services performed," Cahaba instructs.