3 Things I Learned about Hospice Billing

I learned a lot volunteering at a local hospice agency in the billing department.  In addition to working with a knowledgeable and professional hospice billing staff, I discovered a lesson of how the performance of a billing department impacts all areas of the hospice agency.  Here are a few of my lessons learned to share:

1. Spend a day in the billing department

The people who talk to patients, patient families, physicians, insurance companies, etc… have a unique perspective of all the moving parts related to managing a hospice agency.  The billing staff manages costs, cash flow as well as other financial aspects of ensuring a compliant and profitable business. By having a clinician spend a day in the billing department, they can see first- hand why the need of accurate and complete patient clinical information is essential to the business operations.  Furthermore, it will instill a sense of responsibility towards the financial success of hospice agency and the bottom line.

2. Create Special Billing Instructions for Covered Services

When in doubt, or as a reminder, write it down. Hospice billing software should make it easy to include customized notes related to special billing instructions by patient or by insurance. All Hospice claims are to be billed on a monthly basis. This includes services of physical therapy, occupational therapy, respiratory therapy and speech-language pathology and more. Make it easy to denote instructions to make the billing process easier.  

The Hospice Center on the CMS website found at http://www.cms.gov/Center/Provider-Type/Hospice-Center.html is a good resource to refer to when in doubt and guidance is needed. Or, the Medicare Center for New Billers is another resource for homecare and hospice billing found at http://www.cgsmedicare.com/hhh/education/materials/pdf/New_Biller_Resources.pdf

3. Get Prior Authorization Requirements

Prior authorization is required for admission into a Hospice program. Prior authorization
is also required for all services unrelated to hospice diagnosis. It is essential to verify the recipient’s eligibility each time a service is provided. In addition, hospice providers must coordinate efforts with non-hospice providers to ensure that prior authorization is obtained for all services not related to hospice benefits.