U.S. healthcare spending is on track to pass $4 trillion each year, and hospice-based billing now accounts for $20 billion of this market.1,2 Without effective and efficient hospice billing and claims processes, hospice agencies face a dual challenge of making profitability while meeting patient-centered care. If claims are held up in red tape or rejected outright, hospices may struggle to meet revenue targets; in turn, boosting the focus on bottom lines and limiting their ability to deliver top-tier hospice care.
The right hospice software solutions can help hospices strike a balance between speed and accuracy to confidently navigate billing and claims challenges. Here’s how.
Increase Medicare Carve-in Confidence
On January 1st, 2021, the Center for Medicare and Medicaid Innovation (CMMI) launched a small-scale demonstration of its value-based insurance design (VBID) model for hospice, often called the Medicare Advantage (MA) hospice carve-in. According to the Centers for Medicare & Medicaid Services (CMS), the incorporation of the Medicare Hospice Benefit into MA offers dual benefits of both increased patient access and improved continuums of care. Plus, the uptake for participating providers has already been substantial.3,4
Hospice software systems play a key role in boosting carve-in confidence by ensuring all relevant patient, plan and provider data is accurately collected, stored and reported. Hospices are then better equipped to reduce the time between claims submission and approval.
Timely NOE Filings
Notices of election (NOEs) for Medicare-covered hospice services must be submitted within five calendar days after the initial hospice admission date. Improperly completed or late-filed NOEs may be returned for correction, but depending on the type of error — for example, a recently changed beneficiary identifier — this return may not happen immediately. In these cases, the NOE will be fully processed by Medicare before being returned, meaning hospices could face a substantive delay.5
According to the CMS: “When an NOE is submitted within the five day timely filing period, but the NOE contains inadvertent errors, the error does not trigger the NOE to be immediately returned to the hospice for correction. In these instances, the hospice must wait until the incorrect information is fully processed by Medicare systems before the NOE is returned to the hospice for correction.”6
Even small errors could result in substantive delays for Medicare approvals. And while these delays may qualify for NOE timely filing exemptions after the fact, this remains frustrating for hospice providers and patients alike. But robust hospice EHR tools can help collect accurate and up-to-date patient data to ensure NOE filings comply with the NOE five-day window.
Reduce Claims Submission Error Rates
Approximately 8% of Medicare Advantage claims are denied on average, and around 17% of claims through HealthCare.gov plans are similarly rejected.7 As noted by Hospice News, human error is the leading cause of these claims denials — from missing data to incorrectly-entered information, denials are often tied not to malicious action, but instead to the sheer amount of patient and provider data that must be accurately collected and submitted.8
Hospice management software can help providers better navigate billing and claims complexity by automating key data collection and forms completion processes. This not only increases the speed of claims submission but it can also substantially reduce the risk of human error, and let staff focus on what they do best: provide patient-centered care.
Ready to boost billing accuracy and streamline claims submissions? Start with Net Health for Hospice.
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1 Health Affairs, “National Health Care Spending In 2019: Steady Growth For The Fourth Consecutive Year,” December 16, 2020.
2 National Hospice and Palliative Care Organization, “Hospice Facts and Figures,” August 20, 2020.
3 Centers for Medicare and Medicaid Services (CMS), “Introduction to the CY 2021 Hospice Component,” 2020.
4 Hospice News, “Hospices See Rising Volume, Billing Challenges in Medicare Advantage,” April 13, 2021.
5 & 6 Centers for Medicare and Medicaid Services (CMS), “Medicare Claims Processing Manual Chapter 11 – Processing Hospice Claims,” October 30, 2020.
7 Kaiser Family Foundation (KFF), “Claims Denials and Appeals in ACA Marketplace Plans,” January 20, 2021.
8 Hospice News, “Prevent Billing Errors to Reduce Hospice Claim Denials,” September 27, 2019.