Article Highlights

• Document “reasonable and necessary” services when providing care to terminally ill patients.
• Medicare will audit services at a later time to evaluate the validity of care provided.
• Good documentation leads to good medical billing to receive — and keep — revenue for services provided.

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For patients diagnosed with a terminal illness, the Medicare hospice benefit provides coverage that goes beyond what Medicare would normally cover in standard situations. For hospice agencies providing the care, the Medicare hospice benefit introduces a new set of billing and documentation challenges that must be closely monitored.

The key is that services provided to a patient must be proven to be “reasonable and necessary” to help ease the course of a terminal illness for the patient. This requires extensive documentation.

What could end up happening is that Medicare comes back to your agency months or years down the road to review the services provided and asks for proof that the services fit the care. Without the proper proof, Medicare could retroactively deny your claims and take back the money they disbursed to your agency.

We don’t want that to happen to your agency. That’s why it’s important for your team to learn how billing and documentation work for the Medicare hospice benefit. Otherwise, you risk improper billing and documentation that could lead to cash flow challenges down the road.

How Can You Support Billing for Medicare Hospice Benefit?

The plan of care for terminally ill patients is highly complex, consisting of a variety of professional treatments, medications, and diagnostic tests. We recommend providing your team with the resources they need to understand the various aspects of services that can be provided, how to bill for these services, and how to document everything that was reasonable and necessary.

1. Educate Personnel on This Unique Type of Medicare Coverage

The first step to address billing and documentation discrepancies is to provide education to employees on the intricate details involved in this type of Medicare coverage plan. Specifically, they need to understand what relevant services can be provided. Consider this general list of services:

• Physician and nurse practitioner services
• Nursing care
• Medical appliances and supplies
• Drugs for symptom management and pain relief
• Short-term inpatient and respite care
• Homemaker and home health aide services
• Counseling
• Social work service
• Spiritual care
• Volunteer participation
• Bereavement services

Within each service are specific requirements to meet the standard for being reasonable and necessary. This is why we highly recommend documenting each step in the process from deciding to provide the care to actually providing the care.

2. Document Your Processes Providing Each Service

Medicare wants to understand exactly why a certain service was provided, how often the service was provided, how the service was provided, and what the outcome was of the service.

If it helps your team, establish a workflow or process flow to help caregivers capture everything that went into decisions when providing care. You must be able to show that the patient required these services to ease their current condition. Consider incorporating these questions into the workflow:

• What pain was the patient experiencing or expressing?
• What was the severity of the pain?
• How often was the problem presenting itself?
• What service was provided?
• How often was care administered?
• Why was the care deemed reasonable and necessary?
• What were the results of the care?

You should ultimately be able to answer the question of when you cared for a patient, did you document everything that went into the service provided? Then, when Medicare comes back to audit the services provided, you have proof to validate that everything was reasonable and necessary.

3. Ensure Proper Medical Billing for Medicare Hospice Benefit

Great documentation means correct medical billing that will insulate you from Medicare’s audit. But, poor or inconsistent documentation that leads to incorrect medical billing could lead to Medicare taking your money back.

Documentation flows directly into medical billing to ensure that you accurately bill for the services provided and that you can support any inquiries that the services were reasonable and necessary.

However, we understand that billing for the Medicare hospice benefit is extremely complex and complicated. Even with great documentation, your team may not get the billing correct when submitting claims to Medicare. That’s where we can step in to provide outsourced billing services.

At Precision Medical Billing (PMB), we specialize in medical billing to help our clients receive payment for services provided. We can fill gaps in time, knowledge, or skills to handle medical billing to help optimize cash flow in your agency.

Contact Precision Medical Billing for Medical Billing Services

Our goal is to help your agency receive payment for the services provided to each patient through our medical billing service. But, if you want to keep the money, you need documentation to validate the services that you claimed to Medicare.

While we do not provide documentation services, we can certainly walk you through the process of lining up your documentation with what’s required by Medicare. This will benefit your organization by ensuring that your team understands how to document reasonable and necessary services before we handle the medical billing aspect.

If you are interested in learning more about how PMB can help your team with complicated Medicare billing, please call us today to schedule a free consultation. We’re here to help your agency improve collections so that you can receive — and keep — payment for services provided to patients.