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Hospice and home health providers want to ensure that their billing is accurate. Medicare, Medicaid, and private insurance companies may deny reimbursement if a claim is not filed correctly. The family members of patients also need to be able to trust that the provider is not overcharging them for services. Here are eight ways to ensure that your hospice billing is accurate.
The first step to filing an accurate claim is knowing the correct codes to use. The International Classification of Diseases (ICD) is a system health care providers use to classify diagnoses and reasons for procedures. The Current Procedural Terminology (CPT) codebook lists the codes for every procedure that can be billed to Medicare. The Healthcare Common Procedure Coding System (HCPCS) is used for supplies, equipment, and non-physician services such as ambulance transportation and physical therapy. Make sure you are using the most up-to-date versions of these codebooks.
Before submitting a claim, double-check that all the information is correct. This includes the patient’s name, date of birth, social security number, diagnosis, procedure, and dates of service. Incorrect or missing information will delay the processing of the claim or result in a denial of payment.
Modifier codes indicate that a service or procedure was performed differently than usual or provide additional information about a service. For example, if a patient were seen in the office and then had surgery on the same day, the CPT code for surgery would have the modifier -51 (indicating that it was performed on an outpatient basis). Modifier codes are also used to indicate when multiple procedures were performed simultaneously or when there was some type of complication. Medicare has a list of modifiers that can be used on hospice claims.
It is essential to keep accurate medical records for each patient, including progress notes, physician orders, and discharge summaries. These records should be kept on file for at least four years after the date of service. In addition, keep track of related documents such as laboratory results and X-rays. These may be required when you submit a claim for reimbursement.
Medicare has specific rules for what can be billed on a hospice claim form. For example, only one primary diagnosis can be listed per claim form, and only certain types of drugs can be included. In addition, there are rules about how often patients can be seen and what types of services can be provided. Be sure to familiarize yourself with these rules before you submit a claim form to Medicare.
Like Medicare, Medicaid also has its system for coding diagnoses and procedures. Be sure you are using the most up-to-date version of the Medicaid provider manual when billing for services. In addition, some states have unique requirements for Medicaid claims, so check with your state’s Medicaid office before submitting a claim.
Some insurers require pre-authorization or pre-certification before they will approve payment for certain services. If this is required, make sure you get prior approval from the insurer before providing any services to the patient.
Many health care plans have deductibles & copayments, which patients must pay at the time services are rendered. Be sure you understand what portion of the bill must be paid by patients so there will not be any surprises when they receive their invoices. Hospice & home health providers need to ensure that their billing practices are accurate to get reimbursed by Medicare, Medicaid, & private insurers.
In addition, family members need to trust that providers are not overcharging them for services. Hospice & home health care providers need to be aware of the different requirements for billing Medicare, Medicaid, and private insurers. In addition, providers should keep accurate medical records and understand the rules for coding diagnoses and procedures. Following these tips ensures that your hospice or home health agency is appropriately reimbursed for your services.
To get paid for the services you provide, it is crucial to understand how to bill Medicare, Medicaid, and private insurers. Ensure you are using the most up-to-date codebooks and that all the information on your claim forms is accurate. In addition, be familiar with the rules for hospice billing and get prior approval from insurers when necessary. By following these tips, you can ensure you will be reimbursed for your services.