We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare Part A for this while she remains on Hospice?



Yes, in this example, you can bill both Hospice and Medicare A. To utilize both at the same time, the reason for skilled services must be unrelated to the reason for Hospice services. Once skilled therapy services related to the hip Fx are discontinued, issue a NOMNC and end Med A billing.

 Medicare Benefit Policy Manual – Chapter 8

20.3.1 – “Hospices contract with SNFs for services related to the beneficiary’s terminal condition. These bills are not processed by the A/B MAC (A) or (HHH). However, there will be situations where a beneficiary is admitted as a hospice patient, but later requires daily skilled care unrelated to the terminal condition. If the beneficiary was initially admitted as a hospice patient prior to the date sanctions were imposed, and meets the requirements for Part A coverage; sanctions will not be applicable. Benefits will be paid under SNF PPS from the first date the beneficiary qualifies for Medicare Part A for care unrelated to the terminal condition. The facility must complete the Medicare-required assessments from the start of care for the unrelated condition.”

 Medicare Claims Processing Manual – Chapter 6

20.2.2 – “Hospice care related to a beneficiary’s terminal condition is excluded from SNF PPS and consolidated billing.” “Services unrelated to the beneficiary’s terminal condition are designated by the presence of condition code 07. Such unrelated services are included in SNF PPS and consolidated billing


Blog by Angie Hamer, RN, RAC-CT Proactive Medical Review

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