MHCP Provider Manual, Hospice Services, Coordination of Benefits

Hospice services are covered by Medicare, private insurance companies, MHCP and Managed care organizations (MCO) programs. The elected hospice provider must bill all other possible payers before billing MHCP.

Depending on the members available coverage, the coordination of benefit would be as follows:

• Dual eligible: Bill Medicare as the primary payer followed by any private insurance and then MA if the member is responsible for any balance after other payments. (In most cases, Medicare will pay the full amount.)

• MA and private insurance: Bill the private insurance first and then MA

• MA only: Bill hospice care direct to MA

• MCO and prepaid health plan (PPHP) members and providers: Contact your selected health plan for coordination of benefits information

Note: Regardless of other payers identified for a member living in an LTCF, bill MA only for the room and board. This includes MA members, dual eligible, or MCO members.