In New Jersey, billing for hospice room and board involves specific guidelines. When a Medicaid/NJ FamilyCare FFS hospice beneficiary is residing in a nursing facility (NF), the hospice is reimbursed for room and board at a per diem rate calculated at 95% of the approved Medicaid NF per diem rate. The hospice must bill using HCPCS code T2046, and the claim should be submitted within 180 calendar days from the date of service.
Key points to consider:
- Reimbursement Basis: The room and board rate is calculated as 95% of the approved Medicaid NF per diem rate, excluding retroactive adjustments and special program rates.
- HCPCS Code: Use HCPCS code T2046 for hospice room and board.
- Claim Submission: Claims must be submitted within 180 calendar days from the date of service.
- Beneficiary's Available Income: The beneficiary's available income is deducted from the NF's room and board rate to determine the Medicaid reimbursement.
- Hospice Responsibility: The hospice is responsible for managing the room and board reimbursement to the NF.
- Timely Filing: Claims must be submitted within 365 days from the date of service for corrected claims.
- Room and board in long-term care facilities under MLTSS (Managed Long Term Services and Supports) is handled by the long-term care facilities, and the MCO (Managed Care Organization) reduces the payment to facilities by the cost share amount.
Additional information:
- When a hospice patient is in a nursing facility, the hospice is responsible for managing the room and board reimbursement to the NF.
- The hospice beneficiary is removed from the Long Term Care Facility billing system when they elect hospice benefits.
- If the beneficiary revokes hospice and returns to NF care, the NF must complete and submit a Long Term Care Turnaround Document (TAD).
- The hospice must provide prior notification for hospice room and board services.
- A physical street address must be used for billing purposes
Resources:
Hospice Room and Board Reimbursement
All admissions to NJ Medicaid require specific documents to be completed and uploaded to Salesforce.
Through Salesforce you get approval reference # that documentation submitted is acceptable to proceed with billing. This is not an authorization through Salesforce
The Hospice ISR Online Access forms are attached in order to request access to Salesforce if this is not already accessible by Hospice Tools.
The completed forms will be mailed to Yasayra.Rivera@dhs.nj.gov - main email address for NJ Medicaid access queries is DMAHS.Hospice@dhs.nj.gov
If Hospice Tools doesn’t already have access - to verify coverage and get remits register as a user at Welcome to New Jersey Medicaid 1
The forms that need to be completed for every NJ Medicaid patient (including MCO’s so these docs/this process may already be in place at HT but going to add here just in case)
378 - Election of Hospice Benefits
379 - Hospice Benefit Periods Statement
380 - Representative Statement
383 - Hospice eligibility form – accompanies all the above listed forms
POC - they also require the Plan of Care to be uploaded which is from patients medical records, this is not a separate Medicaid form
FS - patient Face Sheet printed out from HT, also from patient Medical Record and not a Medicaid form
Additionally for discharge from Hospice services, one of the following forms would need to be used and will need to be uploaded to Salesforce along with the original 383 updated to reflect either the discharge (#10.) or Transfer (#11.) information :
381 - Revocation (used only for Revocation type discharges)
384 - Hospice Transfer to another Hospice
General billing info for Room and Board –
Rev Code 0658
HCPCS T2046
Bill on form CMS1500 format
If Salesforce approves all the forms submitted for a patient and the bill format is as per the above, then billing and payment should be straight forward.
NJ Medicaid does not pay date of death and all final claims will have a date of death cutback. In the case of a date of death cutback – the 5% contractual deduction will only be taken from total on payable days.
The most common denial is that the NPI and/or MOLINA (Facility Gainwell #) do not match Medicaid’s records. The list of facility names, MOLINA and rates is also available on NJMMIS.
Another non-payable error occurs when a facility starts their billing for the date of discharge from Hospice when a patient Revokes or Discharges Alive.
Forms:
Hospice ISR Online Access Form to be Completed