Medicare Hospice Incorrect Billing Initiative Includes Medicare Dual Special Needs Members
Date: 11/15/23
When Medicare members are enrolled in the hospice benefit, CMS is responsible for payment to providers for hospice services. A Medicare member who elects hospice care but chooses not to disenroll from their Medicare Advantage plan, is entitled to continue to receive, through their plan, any benefits other than those that are the responsibility of the hospice.
Wellcare by Allwell reviews paid Medicare hospice claims and recoups if our member is enrolled in the hospice benefit.
Currently, only claims for traditional Medicare Advantage members are included in the hospice claim review. Effective 1/15/2024, claims for Wellcare by Allwell Dual Special Needs members with claim processed date on and after 1/15/2024 will be part of this hospice claim review.
Exceptions:
- Excludes Medicare Part D (drug coverage) claims and Supplemental Services
- Excludes claim lines with Modifier GW, claims with Condition Code 07, and claim lines with procedure codes S5170 and S5161
Reference:
If you have questions, please contact your AzCH Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us.