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Medicare Payments for Unallowable Overlapping Hospice Claims and Part B Claims

According to 42 CFR 418.24(d), a hospice beneficiary waives all rights to Medicare payments for any services that are related to the treatment of the terminal condition for which hospice care was elected or treatment of a related condition or treatment that is equivalent to hospice care. Excepted are those services provided by another hospice under arrangement or by an independent attending physician. The hospice agency assumes responsibility for medical care related to the beneficiaryís terminal illness and related conditions. When a service that is related to the hospice patientís terminal illness is furnished by an outside provider, other than an independent attending physician, the provider must look to the hospice for payment. Medicare should not make a separate payment to the outside provider. Prior OIG audits, investigations, and inspections have identified this area for noncompliance with Medicare billing requirements. We will review Medicare Part A payments to hospices to determine whether claims billed to Medicare Part B for items and services were allowable and in accord with Federal regulations. Generally, certain items, supplies, and services furnished to inpatients are covered under Part A and should not be separately billable to Part B.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2017 Centers for Medicare & Medicaid Services Medicare Payments for Unallowable Overlapping Hospice Claims and Part B Claims Office of Audit Services W-00-17-35797; A-09-17-03021 2018

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