Hospice Services

Federal regulations require that Medicare fee-for-service contractors (Medicare fiscal intermediary, administrative contractor, DME regional carrier, Part D or prescription drug plan or another carrier) maintain payment responsibility for Medicare Advantage members who elect hospice care. Claims for services provided to a Medicare Advantage member who has elected hospice care should be billed to the appropriate Medicare contractor.

• If the member elects hospice care and the service is related to the member’s terminal condition, submit the claim to the regional home health intermediary. 
• If the member elects hospice care and the service is not related to the member’s terminal condition, submit the claim to the Medicare fiscal intermediary, administrative contractor, DME regional carrier, Part D or prescription drug plan or another carrier as appropriate. 
• If the service is provided during a lapse in hospice coverage, submit the claim to the local Blue plan. Note: Original Medicare is responsible for the entire month that the member is discharged from hospice. 
• If the service is not covered under Original Medicare but offered as an enhanced benefit under the member’s Medicare Advantage (for example, vision), submit the claim to the local Blue plan. 

Medicare Advantage member cost-share for hospice services 

As provided in 42 CFR § 422.320, a Medicare Advantage Organization (MAO) must inform each enrollee eligible to select hospice care about the availability of hospice care if: (1) a Medicare hospice program is located within the plan’s service area; or (2) It is common practice to refer patients to hospice programs outside the (MAOs) service area. 

A Medicare Advantage enrollee who elects hospice care but chooses not to disenroll from the plan is entitled to continue to receive (through the Medicare Advantage plan) any Medicare Advantage benefits other than those that are the responsibility of the Medicare hospice.  Through the Original Medicare program, subject to the usual rules of payment, the Centers for Medicare and Medicaid Services (CMS) pays the hospice program for hospice care furnished to the enrollee and the MAO, providers and suppliers for other Medicare–covered services furnished to the enrollee. 

The table below summarizes the cost-sharing and provider payments for services furnished to a Medicare Advantage plan enrollee who elects hospice.