MHCP Provider Manual, Hospice Services, Bed-holds

When a hospice patient resides in a nursing home and is absent from the nursing home for hospitalization, home visits, etc., the hospice agency must verify that the nursing facility is eligible for the bed-hold days. Bed-hold days are available for up to 18 consecutive days per hospital admission and 36 days annually for therapeutic leave days when the facility occupancy rate is 96 percent or greater. Bed-hold day rates are 30 percent of the case-mix rate, of which the agency is entitled to 95 percent of the adjusted case-mix rate for that LTC facility.

Example: If the entire stay is May 1–10, with May 1–7 in the nursing home, submit revenue code 0658 with the case-mix for May 1–7. For the May 8–10 hospital stay days, submit revenue code 0185 with only the rate of charges billed.

Revenue code 0185 will pay only the submitted amount; use code 0185 only for hospital or therapeutic leave days when billing for hospice.