Navigating the VBID hospice benefit in 2023
The Centers for Medicare and Medicaid Services (CMS) first launched its value-based insurance design (VBID) model in 2021. The model tests Medicare Advantage health plan innovations designed to reduce Medicare spending and improve the quality and delivery of care for Medicare beneficiaries. The VBID model’s hospice benefit is a component of the larger 2021 model and is set to be tested through 2024.
For calendar year 2023, the VBID hospice benefit will be offered in 25 states and territories and 15 Medicare Advantage (MA) plans will be participating. This VBID Hospice Benefit Contact spreadsheet lists the states and counties where participating MA plans will be operating in 2023. If your state is participating, the VBID hospice component can introduce billing and coding complexities that could impact reimbursement. It can also mean more work from a billing and coding perspective, leaving staff with less time for patients.
How the VBID hospice benefit works
The VBID hospice benefit is designed to assess how adding the Medicare Part A hospice benefit into MA plans will impact cost, quality and timely access to hospice care. But it can also impact reimbursement for hospice agencies.
Typically, when an enrollee in an MA plan chooses hospice care, Original Medicare is financially responsible for most services and the MA plan only pays for supplemental benefits. Under the hospice benefit of the VBID model, participating MA plans are the primary payer for all fee-for-service Medicare benefits, including hospice care.
What this means for your hospice agency:
- You must submit all notices of election and claims for hospice services to both Medicare and the participating MA plan. The MA plan will process for payment and Medicare will process for informational purposes related to the VBID model.
- If you contract with the MA plan for hospice services, confirm their billing requirements to help ensure timely reimbursement. If you choose not to contract, the MA plan must at least pay you rates equal to Original Medicare for Medicare-covered hospice services.
- Prior authorization requirements around hospice elections or transitions between different levels of hospice care do not apply under the VBID model.
How to bill for timely reimbursement under VBID
Follow these tips when filing claims under the VBID hospice benefit to keep common mistakes from taking a toll on your time and your cash flow.
- Confirm patient eligibility up front
Eligibility is essential to your revenue cycle management. Confirming the patient’s coverage, benefits, copayments and deductibles is critical to filing more accurate claims and preventing reimbursement delays. Know what insurance your patient has and be sure to check it at the beginning of each month. - Set up accounts accurately and follow up on claims
Under the VBID hospice benefit, you’ll need to bill both Medicare and the MA plan. But most systems won’t send claims for the same service to both Medicare and MA without some type of manual intervention. You’ll need to manually set up accounts to ensure the system sends claims to both. If you miss billing the MA plan, which is the payer under VBID, it can create cash flow issues for your agency. Also, the MA plans participating in the VBID model can change each year and each MA payer has their own set of requirements for submitting claims. Keeping up with these individual requirements is key to timely reimbursement, but it can also be time-consuming. - Send notices of election (NOEs) on time
The five-day rule to submit NOEs still applies under the VBID hospice benefit. Sending the notices late can mean lost revenue because you’ll be penalized for each day the NOE is late once the five days have passed. For example, if you submit on day six — just one day late — you’ll lose a full six days of revenue because you are penalized for the initial five-day window in addition to day six.
Protect your time and cash flow
We specialize in home health and hospice and can help you navigate the VBID hospice benefit more easily and efficiently to reduce the impact on your staff and your revenue cycle. We know which states, counties and MA payers are participating in the VBID model and can help you set up accounts accurately in your system right from the start. We’re experts in Medicare billing and coding and understand the different Medicare Advantage payor requirements, so we can help make sure you meet filing deadlines and avoid costly errors that can delay reimbursement. See how outsourcing your medical billing coding can give you more time for patients while protecting your cash flow. Connect with us today.
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Sue Weeks
Sue possesses a diverse range of experience in the Home Health and Hospice field, including firsthand involvement in managing authorizations, accounts receivable, and various other revenue cycle positions within Home Care and Hospice agencies. Additionally, she has played a pivotal role in software implementation, specifically in the financial model, where she trained customers on best practices, software functionality, and system administration. Sue's experience includes working closely with payors, particularly Medicare, and she has become a subject matter expert on the specific billing rules and regulations applicable to Home Care and Hospice.
Currently serving as the Project Manager for the Revenue Cycle Division, Sue leverages her skills and knowledge to develop optimal workflows for the RCM team, update auditing and quality measures, provide training, and collaborate with customers to enhance their billing and accounts receivable processes.
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