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Billing Medicare Advantage Organization Claims for Hospice


Effective January 1, the Centers for Medicare and Medicaid Services (CMS) implemented the Value-Based Insurance Design (VBID) Model for hospice and palliative care patients enrolled in Medicare Advantage plans.

The new VBID Model requires hospice organizations to submit claims to both CMS and Medicare Advantage Organizations (MAOs) for the model’s duration, which is scheduled to run through 2024.

To accommodate the requirements of the VBID Model, hospice providers should adjust operating procedures using an innovative hospice software that is up to date on all Medicare regulations.

Changes on Admission with the VBID Model

Under the VBID Model, hospice organizations must submit two Notices of Election (NOEs) on admission.

The NOE submitted to CMS is used for tracking and informational purposes, while the NOE submitted to the MAO is used for payment processing. Both NOEs must contain the same information and must be submitted and accepted by the payers no later than five days after admission to avoid missed reimbursement.

NOEs are automatically generated in Axxess Hospice, with the Election Form, Certificate of Terminal Illness and the Initial Assessment auto-populated under the Billing tab, ready for the user to verify and submit in one place.

Submitting Claims Under the VBID Model

Claims for payment must also be submitted to both CMS and the participating MAO, using the same form for each claim.

CMS will continue to send remittance advice for the claims sent, even though they are non-payment claims. The remittance will have the following adjustment codes and messages:

  • Claim Adjustment Reason Code (CARC) 96: Non-covered charge(s).
  • Remittance Advice Remark Code (RARC) MA73: Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare, as patient has elected managed care.
  • Group Code Contractual Obligation (CO): MAOs participating in the VBID Model’s hospice benefit component will be responsible for coverage of hospice services.

Axxess Hospice has built-in functionality to automatically generate duplicate claims for VBID Model participants. CMS claims will continue to be processed through the Axxess DDE system while MAO claims will be processed through the RCM solution. Both claims must be verified before submission.

Discharging Patients Through the VBID Model

Patients who discharge from the hospice organization will also need to have a Notice of Termination/Revocation (NOTR) submitted to CMS and the MAO.

The timing for NOTR submission is the same for CMS as it is for the participating MAOs.

Submitting an NOTR in Axxess Hospice is as efficient a process as the NOE submission, since both notices are found under the Billing tab. The Revocation/Discharge Date, Discharge Visit and Revocation Statement will auto-populate in one place, ready for the user to review and verify all information, then click “Submit.”

This insurance model aims to test the impact of care delivery and the quality of care when the Medicare Advantage plans are financially responsible for all benefits, rather than paying by service. Selecting a hospice software offering a streamlined functionality of the VBID Model claims process will reduce the regulatory burden for hospice organizations, allowing more time to prioritize patient care.

Axxess Hospice is a cloud-based hospice software that supports efficient documentation at the point of care, easing the strain of regulatory changes off clinicians.

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