N.D. Medicaid Billing and Policy Manual, Hospice Services, Documentation Requirements

General Requirements

Providers must keep legible medical and financial records that fully justify and disclose

the extent of services provided and billed to ND Medicaid. Records must be retained for

at least 7 years after the last date the claim was paid or denied. Providers must follow

the documentation requirements in the Provider Requirements Policy.

Inpatient Hospice Care

A member may need care as an inpatient on a short-term basis during a period of crisis.

To meet this need, the hospice or facility under contract to provide inpatient hospice

care must provide 24-hour nursing services. Nursing services must be sufficient to meet

the total nursing needs and be consistent with the member’s plan of care. The inpatient

facility must provide treatments, medications, and diet as prescribed, and keep the

member comfortable, clean, well-groomed, and protected from accident, injury, and

infection. The inpatient facility must employ a registered nurse on each shift to provide

nursing care.

Inpatient Respite Care

Inpatient respite care may be provided on an occasional basis to give the member’s

family or caregiver a break from the full-time responsibility of providing care. Payment

for inpatient respite care may not exceed five consecutive days of inpatient respite care

at a time.

Discharge from Hospice

Hospice may discharge a patient if:

• The patient moves out of the hospice's service area or transfers to another

hospice;

• The hospice determines that the patient is no longer terminally ill; or

• The member passes away.

Bereavement Counseling

The hospice must make bereavement services available to the member’s family for at

least one year after the member’s death. Family includes persons related to the

member or those considered by the member to be family because of close association.

No Medicaid payment is made for bereavement counseling.

Payment for Physician Services

Daily hospice care rates include payment for the administrative and general supervisory

activities performed by the medical director or a physician member of the

interdisciplinary team. These activities include participation in establishment of plans of

care, supervision of care and service, periodic review and updating plans of care, and

establishment of governing policies. The cost of these activities may not be billed

separately.

The hospice may be paid at the current Medicaid rate for physician services provided

for purposes other than those listed above if the physician is an employee of the

hospice or provides services under arrangement with the hospice. Payment is not

available for donated physician services.

Payment may be made for personal professional services provided by a member’s

attending physician, if the physician is not an employee of the hospice, not providing

services under arrangement with the hospice, or does not volunteer services to the

hospice. Costs for services other than personal professional services, such as lab or x-

ray, may not be included on the attending physician’s bill and may not be billed

separately.

Room and Board Payment for Members in Long-term Care

Facility

The hospice is responsible for paying room and board when providing care for a

member residing in a long-term care facility. In this situation, payment to the long-term

care facility by ND Medicaid is no longer available. The hospice is responsible for

including the room and board charges on the claim for the amount equal to the Medicaid

rate payable to the long-term care facility at the time the services are provided. The

hospice may not negotiate a room and board rate with the long-term care facility except

for payment for private room accommodations. No additional payment will be made to

the hospice for negotiated private room rates.

If a member has a recipient liability, the amount will be shown on a remittance advice.

The hospice is responsible for collection of this amount from the member. The hospice

may arrange with the long-term care facility to collect the recipient liability. ND Medicaid

will not reimburse the hospice for any uncollected recipient liability.

A hospice claim must be submitted for all members electing hospice who reside in a

long-term care facility even if no payment is due from ND Medicaid and payment is

made entirely by Medicare, insurance, or any other payment source.