Wiki Medicare Advantage Hospice - Hospital Stay

[KyleCole]

I have a patient (medicare advantage) who elected Hospice effective 03/16, was admitted to the hospital on 03/31. AFTER he was admitted to the hospital, Hospice was "revoked". Would Original Medicare be responsible for the entire stay at the hospital? Or would he have to be re-admitted?

 

[kbarron]

What is the reason for revocation? Does the pt still have the Medicare Advantage plan? Is there a hospice benefit on this plan?

 

[KyleCole]

I believe they were seeking progressive treatment. They were admitted on 03/31 and revoked later that day. My question is really based on this law below, would original medicare be primary over the medicare advantage plan for the entire stay, since the patient was admitted before the capitation payments started again on 04/01? or how would that work?


§ 417.585
Special rules: Hospice care.

(a) No payment is made to an HMO or CMP on behalf of a Medicare enrollee who has elected hospice care under § 418.24 of this chapter except for the portion of the payment applicable to the additional benefits described in § 417.592. This no-payment rule is effective from the first day of the month following the month of election to receive hospice care, until the first day of the month following the month in which the enrollee resumes normal Medicare coverage.

(b) During the time the election is in effect, the HMO or CMP may bill CMS on a fee-for-service basis (subject to the usual Medicare rules of payment) but only for the following covered Medicare services:

(3) Services furnished after the revocation or expiration of the enrollee's hospice election until the full monthly capitation payments begin again.

 

[kbarron]

I do not have a link however The Center for MCR and MCD svcs has a booklet on the internet for Hospice. Not sure if this overrules the law you have quoted. I would think that if they were appvd and denied the same dos that you could not bill hospice only traditional MCR. Good luck