Wash. HCA Hospice Services Billing Guide, How does HCA determine what rate to pay?

Note: Prior to submitting a claim to HCA, a hospice agency must

file written certification in a client’s hospice record. (See Are

election statements required in the client’s hospice medical

record? and What is the hospice certification process?)

HCA pays for hospice care provided to clients in one of the following settings:

• A client’s residence

• An HCA-approved nursing facility, hospital, or hospice care center

To be paid by HCA, the hospice agency must provide and/or coordinate HCA-

covered hospice services including:

• Medicaid hospice services.

• Services that relate to the client’s terminal illness any time during the hospice

election.

Hospice agencies must bill HCA for their services using hospice-specific revenue

codes (see What places of service are allowable?).

HCA pays hospice agencies for services (not room or board or both) at a daily

rate calculated by one of the following methods:

• Payments for services delivered in a client’s residence (routine and continuous

home care) are based on the county location of the client’s residence for that

particular client.

• Payments for respite and general inpatient hospice care are based on the

county location of the providing hospice agency.

HCA reduces hospice payments by two percent for providers who did not comply

with the annual Medicare Hospice Quality Reporting Program.

• The payment reduction is effective for the fiscal reporting year in which the

provider failed to submit data required for the annual Medicare Hospice

Quality Reporting Program.

• The payment reduction applies to routine home care, including the service

intensity add-on, continuous home care, inpatient respite care, and general

inpatient care.

• The payment reduction does not apply to pediatric palliative care, the hospice

care center daily rate, or the nursing facility room and board rate.

Note: The daily rate for authorized out-of-state hospice services

is the same as that for in-state non-Metropolitan Statistical Area

(MSA) hospice services.