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Value-Based Insurance Design (VBID) Model Hospice Component

The Centers for Medicare & Medicaid Services (CMS) began testing the VBID Model in Calendar Year (CY) 2021. The hospice benefit component associated with the VBID Model applies to Medicare beneficiaries who have a hospice election start date on or after January 1, 2021, and are enrolled in a Medicare Advantage Organization (MAO) plan participating in the Model.

Prior to January 1, 2021

When a Medicare beneficiary is an MAO enrollee and elects hospice prior to January 1, 2021, the Medicare Administrative Contractor (MAC)/CGS processes claims for hospice services.

On or After January 1, 2021

When a Medicare beneficiary is enrolled in an MAO plan that participates in the hospice benefit component of the VBID Model and elects hospice on or after January 1, 2021, the MAO plan processes claims for payment, not the MAC/CGS.

The MAO participating in the VBID Model will cover:

  • All hospice care from the effective date of election (on or after January 1, 2021) to the date of discharge or revocation
  • Services provided through the end of the month when the beneficiary revokes or discharges from hospice alive
  • Attending physician services
  • All care unrelated to the terminal illness during the hospice election

Note: Patients enrolled in the hospice benefit component of the VBID Model will remain enrolled in the MA plan after a discharge or revocation.

Hospice Billing

Hospice providers MUST also submit a Notice of Election (NOE) and claims to your MAC/CGS  Claims will deny with the following messaging on your Medicare Remittance Advice:

  • Claim Adjustment Reason Code (CARC) 96: Non-covered charge(s)
  • Remittance Advice Remark Code (RARC) MA73: Information remittance associated with a Medicare demonstration. No payment issued under Fee-For-Service Medicare as patient has elected managed care
  • Group Code CO

The provider letters below identify MAOs participating in the Model:

Resources:

Updated: 01.02.24

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