What To Know About Hospice Medicaid Claims

While Medicaid provides coverage to working families, it is also one of the most prevalent forms of financial aid for nursing homes and hospice care facilities. Here are five facts about Medicaid that you might not know.

Coverage has evolved.

Over the past fifty years, Medicaid’s coverage has expanded from children and the disabled to including lower-income individuals and families. With the help of the federal government’s financial matching, Medicaid provides coverage for low-income enrollees who would typically struggle with meeting requirements to be insured.

Those enrolled may receive care through privately managed care plans.

Many Medicaid enrollees receive their care from privately managed care plans contracted with state Medicaid programs to coordinate care efficiently, saving Medicaid dollars.

Medicaid managed care and coverage can change, depending on the patient care.

Hospice care may be covered only by traditional Medicaid in some states, while in others coverage depends on where care is delivered. Patients at home may be covered by managed care, while patients in long-term care facilities may be covered by traditional Medicaid. All states are different and these coverage determinations are constantly evolving.

Medicaid authorization requirements can be tricky.

Medicaid and Managed Care authorization requirements vary by plan. They can also vary by level and location of care. In some states, coverage can change from managed care to traditional Medicaid when a patient enters a nursing home.  The coverage change requires other providers, such as hospices, to obtain new treatment authorizations based on the updated coverage.

It is best practice to confirm eligibility on all Medicaid and Managed care patients monthly.

Because coverage can change month to month, it is most important that hospices verify plan coverage each month for all Medicaid and Managed care patients under their care. Monthly verification can prevent lost coverage days due to no authorization. Monthly verification can also prevent delays in payments by confirming claims are submitted to the correct payers the first time.

Stay on top of your Medicare and Medicaid billing. Let Advanced Hospice Management help you with all of your hospice billing needs. Contact us today!