Medicare Advantage Plan Hospice Coverage

In 2023, the hospice industry saw a major shift with the expansion of the Value-Based Insurance Design (VBID) Model, also known as the Hospice Carve-In. In a recent webinar, Our CEO, Delaine Henry, broke down what this means for hospice providers new to the pilot. Historically, hospice services were carved out of Medicare Advantage and covered exclusively under traditional Medicare. The VBID model changes that by requiring Medicare Advantage plans in selected areas to take on hospice coverage responsibilities—changing how providers bill and how patients receive care. 

What Hospices Need to Know Before Billing

Delaine emphasized the importance of understanding plan participation, verifying eligibility and identifying which patients are under VBID plans. Beginning January 1, 2023, newly participating Medicare Advantage plans are required to pay hospice Medicare-equivalent rates even if the provider is out-of-network. She stressed the need for hospices to submit timely Notice of Elections (NOEs) to both Medicare and the Advantage plan, and to make sure EMR systems are properly configured for dual submissions. 

Communication Is Key to a Smooth Transition

We encourage hospice providers to proactively contact participating plans, verify how they accept claims and NOEs and ensure staff are trained to identify VBID-covered patients. Delaine also highlighted scenarios where previously traditional Medicare patients may switch to Medicare Advantage upon readmission, stressing the importance of checking eligibility every time. 

Contact our team at Advanced Revenue Cycle Management with any questions you might have.