Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 7010

Updated 06/19

Providers must bill the rate for the service based on the KMAP Hospice Rates and instructions in

Appendices II and III of the Hospice Fee-for-Service Provider Manual.

G0155, G0299 U2, T2042, T2042 U2, and T2043 must be billed based upon the county of the member.

T2044 and T2045 must be billed based upon the county of the hospice.

Automated processing of nursing facility and intermediate care facility for individuals with

intellectual disabilities (ICF/IDD) room and board charges for hospice members:

Hospice providers are required to bill the room and board charges for hospice members residing in

nursing facilities (NFs), intermediate care facilities for individuals with an intellectual disability

(ICF/IID), or hospital swing beds. NFs include skilled nursing facilities, nursing facilities, and nursing

facilities for mental health. ICF/IID include privately owned and state institution ICF/IID.

These claims may be submitted on paper, electronically, or through the Internet. Automated processing

will allow these claims to process quickly and accurately by following the instructions below.

• Paper claims: Complete the claim as usual and document the NF, ICF/IID, or hospital swing bed

name in Field 17, the NPI in Field 17b, or the provider identification (ID) in Field 17a.

• Electronic claims (such as 837P): Complete the claim as usual. NF, ICF/IID, or hospital swing

bed providers must be included as the referring provider in loop 2310A or 2420A on

hospice claims.

• Internet claims: Complete the claim as usual and document the NF, ICF/IID, or hospital swing

bed name and NPI in the referring physician field.

• Provider Electronic Solutions (PES): Complete the claim as usual and document the NF,

ICF/IID, or hospital swing bed in the referring provider field under Header 2.

KMAP prefers the NPI is submitted for the referring physician/provider’s identifier but the provider ID

will be accepted until notified otherwise. The referring provider must be enrolled with KMAP.

KMAP is the payor of last resort and is to be billed only after payment has been sought from primary

insurance carriers (including Medicare). Examples are provided below.

• The member resides in a skilled NF and is covered by both Medicare and Medicaid. Election of

hospice benefits from both carriers must occur concurrently.

• The member resides in a NF and has skilled NF insurance coverage. Payment must continue to be

sought from the primary carrier. If additional payment is requested for room and board services

following the primary carrier’s payment, claims submitted must report the primary payment in the

appropriate third-party liability (TPL) amount field.

• The member resides in a skilled NF and meets the criteria to receive Medicare’s skilled nursing

benefit for a condition unrelated to the diagnosis for which hospice care was elected. Billing to

KMAP must occur only after payment has been sought from Medicare or after the exhaustion of

benefits.

As the coordinator of all services, the hospice provider is responsible to ensure all payment sources have

been accessed prior to billing KMAP. Failure to meet this standard and to report primary payments will

result in the recoupment of monies.