Tex. HHSC Medicaid Hospice Provider Manual § 4300

Revision 08-1; Effective November 12, 2008

Actions that may result in withholding of hospice payments, include, but are not limited to:

ownership changes;

failure to submit Form 3071, Individual Election/Cancellation/Update, Form 3074, Physician Certification of Terminal Illness, and Minimum Data Set (MDS) or LON assessment (if applicable);

failure to verify that an individual is Medicaid eligible; or

failure to submit or obtain signatures in the required time frames for Form 3071, Form 3074 and MDS assessment (if applicable).

Reasons for non-payment that cannot be corrected:

Form 3074 is not received within the required time frame. Payments cannot be made before this date.

Hospice providers cannot receive Medicaid hospice payment for dually eligible individuals.

Medicaid eligibility does not exist for the time period billed.

The type of Medicaid eligibility approved for a recipient does not include hospice services.

Form 3071 is effective after the date requested for payment.

Form 3071 indicates that this client was discharged from the hospice program.

Form 3071 or financial eligibility indicates that this client died. Payment cannot be made after this date.

Missing and expired documentation are usually the reasons for non-payment of hospice claims. Be sure all hardcopy forms are legible and complete. Incomplete, incorrect and difficult-to-read forms are returned to providers for correction and could cause delay in payment. Review the form for completeness before submission to TMHP to eliminate problems.

Obtain copay data directly from the local HHSC ME staff for more precise claims processing. Hospice staff should work closely with other HHSC and HHSC staff in order to alleviate rejected claims because of the simultaneous provision of other Medicaid services, Medicaid eligibility approval or incorrect hospice data in the CMS and HHSC systems.