Well, it could. If a Medicare patient elects a Medicare Advantage plan participating in the Hospice VBID Pilot Program and moves outside the VBID geographical area, the plan must still be billed for hospice services.
VBID participation is by plan and state. Hospices in states with participating plans must bill hospice services to both the plan and Medicare and are paid by the plan. This includes filing NOEs based on the plan’s required time frame and method. Hospices cannot “opt-out” or decline participation. If your hospice is in a state with participating plans, you must participate.
But what if your hospice is not located in a state with plans participating in the VBID pilot? You may think you do not have to verify plans listed on Medicare eligibility as participating or not, right? You’re right the vast majority of the time. Do you know under what circumstances you could be wrong?
In the absence of direct guidance from the plan, CMS says if a patient has a VBID plan and moves outside of the geographical area, the hospice services must still be billed to both the plan and Medicare and will be paid by the plan- if all criteria are met. Meaning you must file the VBID plan NOE timely as well.
Whoa! What can you do?
ASK TWO QUESTIONS AT ADMISSION!:
1. Have you recently moved to the state in which you currently reside?
2. If yes, do you have a Medicare Advantage plan?
If both answers are yes, have your intake and/or eligibility department verify the Medicare Advantage Plan ID and cross-reference it to the state in which the plan was purchased. If the state in which the plan was purchased is participating in the VBID pilot, verify if the plan is a VBID participating plan. If so, contact the plan to determine the NOE submission process and send your NOE within five days to both the plan and Medicare. Submit claims to both the plan and Medicare, and the plan will pay for hospice services. That’s it!
Questions? Contact AHM today!