• General Information
  • Introduction
  • Core and Other Functions of Hospice
    • Introduction
    • Core Functions
    • Other Functions
  • Provider Certification
  • Scope of Service
  • Medicaid Provider Responsibilities
  • Hospice Responsibilities
  • Recipient Eligibility
  • Hospice Enrollment
  • Hospice Recipient Requirements
    • Designated Primary Provider
    • Discontinuation or Transfer
    • Recipients Residing in Nursing Homes
  • Copayment
• Covered Services
  • Hospice Care Service Categories
  • Hospice Care Services and Limitations
    • Introduction
    • Routine Care
    • Continuous Care
    • Inpatient Respite Care
    • General Inpatient Care
  • Nursing Home Room and Board
    • Introduction
    • Limitations Applicable to Nursing Home Room and Board
  • Physician Services
  • Durable Medical Equipment/Personal Care Services
  • Reimbursement Not Available
• Required Documentation
  • Introduction
  • Physician Certification/ Recertification of Terminal Illness
  • Recipient Election of Medicaid Hospice Benefit
  • Notification of Medicaid Hospice Benefit Election
  • Plan of Care
  • Ordering Forms
  • Form Retention and Submission
• Prior Authorization
  • Introduction
  • Prior Authorization for Personal Care Services
• Claims Submission
  • Introduction
  • Coordination of Benefits
  • 837 Health Care Claim: Institutional
  • UB-92
  • Billed Amounts
  • Billing Increments
  • Diagnosis Codes
  • Revenue Codes
  • Fee Schedule
• Reimbursement
  • Introduction
  • Nursing Home Room and Board
    • Introduction
    • Paper Adjustment Requests
  • Patient Liability
  • Hospice Cap on Overall Reimbursement
• Appendix
  • Appendix 1 — UB-92 (CMS 1450) Claim Form Instructions for Hospice Services
  • Appendix 2 — UB-92 Claim Form Sample
  • Appendix 3 — Physician Certification/ Recertification of Terminal Illness
  • Appendix 4 — Notification of Medicaid Hospice Benefit Election
  • Appendix 5 — Recipient Election of Medicaid Hospice Benefit
  • Appendix 6 — Hospice Benefit Revocation (Non-recertification)/ Voluntary Discharge
  • Appendix 7 — Allowable Revenue Codes for Hospice Care
  • Appendix 8 — Rounding Guidelines for Continuous Care
  • Appendix 9 — Services Provided Outside the Hospice Benefit
  • Appendix 10 — Sample Adjustment/ Reconsideration Request for Retroactive Nursing Home Rate Adjustment
• PDF

 

 

 

Reimbursement

Patient Liability

For a hospice recipient residing in a nursing home, the nursing home, hospice, and Wisconsin Medicaid each play a role in collecting patient liability. Patient liability is the amount of an individual’s income that is available to apply on a monthly basis toward the recipient’s cost of care.

The nursing home is responsible for:

• Collecting patient liability from the Medicaid recipient residing in their facility.
• Transferring the patient liability amount to the recipient’s hospice.
• Billing the hospice its contracted amount for room and board.

The hospice is responsible for:

• Paying the nursing home the contracted amount for room and board.
• Accepting as income the patient liability amount received from the nursing home and reporting this amount on the claim submitted to Wisconsin Medicaid.
• Indicating its usual and customary amount for nursing home room and board using revenue code 0169 for claims submitted to Wisconsin Medicaid and submitting claims to Wisconsin Medicaid only once per calendar month.

Wisconsin Medicaid is responsible for:

• Deducting the patient liability, as reported to the state by the county, from the amount to be reimbursed to the hospice.
• Reimbursing the hospice 95 percent of the nursing home’s SNF rate minus the patient’s liability.

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