Hi, Amy.
There are not Medicare regulations addressing a change in payor for hospice. If the patient is going from non-Medicare to Medicare, the Medicare hospice election statement must be completed along with the certification of terminal illness and initial and comprehensive assessments. These items must "line up" with the required timeframes, i.e. effective date of election, CTI not more than 15 days prior to start of the benefit period, comprehensive assessment completed within 5 days by full IDG.
If the patient is going from Medicare to non-Medicare, there must be a discharge from Medicare in order to end the Medicare hospice benefit.
The same applies for instances going to/from Medicaid. The state Medicaid requirements may require specific claim coding. Commercial insurance companies may have specific requirements as well.
A new Hospice Item Set (HIS) is not required for payor changes.
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Katie Wehri
Director of Home Health & Hospice Regulatory Affairs
NAHC
Washington, DC
202-240-9254 #3360
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Original Message:
Sent: 01-19-2024 08:20
From: Amy Faylor
Subject: Payer Changes
I am looking for any regulations regarding payer changes and what is required, such as new consents, F2F, referral, etc. Thank you!
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Amy Faylor
Clinical Manager
Parkview Home Health & Hospice
Fort Wayne IN
+1 (260) 373-9800
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