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Kentucky Medicaid identifies hospice services as Provider Type (44). To enroll in and bill Kentucky Medicaid, hospice providers must be:

Covered Services

Medicaid Hospice services are available to beneficiaries with a terminal diagnosis that have been certified by a physician to have a life expectancy of six months or less. Hospice services provide palliative care, relief of pain, and other symptoms, for beneficiaries in the last phase of an incurable disease so that they can live as fully and comfortably as possible. Hospice also provides supportive services to terminally ill beneficiaries and assistance to their families in adjusting to the patient's illness and death. Covered hospice services are available to beneficiaries in their Home, Nursing Facility, or ICF/IID setting. Hospice services are reasonable and necessary for the palliation or management of the terminal illness as well as related conditions as detailed in the hospice regulations.

Eligibility

In order to receive hospice services, the beneficiary must elect hospice coverage using the MAP-374 - Election of Medicaid Hospice Benefit Form.

Beneficiaries who elect hospice will receive treatment for conditions related to their terminal illness by their hospice provider. Beneficiaries younger than 21 who are eligible for hospice benefits are eligible to receive curative treatment in relation to their terminal illness concurrently with hospice services.

Medicare

If an individual is eligible for Medicare as well as Medicaid (dual eligibility), the hospice benefit must be elected and revoked simultaneously under both programs.

Benefits

Hospice benefits consist of two 90-day periods.

An additional 60-day extension of hospice benefits periods is covered until revocation or termination for other reasons such as ineligibility or death. Recertification is required for each 60-day extension benefit period.

Send the MAP-374, MAP-375, MAP-376, MAP-378, and MAP-403 by faxing to DMS at 502-564-0039 or by email.

Mail or fax the MAP-377, MAP-383, MAP-384 and MAP-397 to: 
Carewise Health
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: 800-292-2392, Option 9

Hospice providers must meet the coverage provisions and requirements of 907 KAR 1:330 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.

How do I verify eligibility?

Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net System.

Reimbursement

Reimbursement for hospice services is in accordance with 907 KAR 1:340 and the hospice rates.

Duplication of Service

The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.

Prior Authorizations

Some services may require prior authorization. Hospice services requiring prior authorization must contact CareWise. Also mail or fax the MAP-377, MAP-383, MAP-384 and MAP-397 to:
Carewise Health
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: 800-292-2392, Option 9

Claims Submission

Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service claims. Each MCO processes its own claims.

Coding

Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. KY Medicaid requires the use of CMS 1500 billing forms. Providers will need to bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals

Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing to an MCO claim.

Timely Filing

Claims must be received within 12 months of the date of service or six months from the Medicare pay date whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.

Notice: Effective for dates of service Jan. 1, 2016, and later, hospice providers will be able to bill for service intensity add-on payments for routine home care services provided by a registered nurse or medical social worker during the last seven days of a patient's life. Billing for the service intensity add-on payment should be on a separate line and/or claim from your routine home care payment billing using revenue codes 551 or 561, as appropriate. Procedure code G0299 will be required with the use of revenue code 551 and G0155 will be required with the use of revenue code 561. Service intensity add-on payments must be billed in 15-minute increments (one unit is equal to 15 minutes) and billed on a claim with occurrence code 55 and an associated occurrence date that reflects the member's date of death. Revenue codes 551 and 561 must be billed as a single date of service per line (span-dating is not allowed). Please continue billing for your regular routine home care payments with revenue code 651 using the current billing guidelines and unit increment.

Provider Contact Information

If you can't find the information you need or have additional questions, please direct your inquiries to:

FFs Billing Questions - DXC - (800) 807-1232
General Provider Questions - (855) 824-5615
Prior Authorization - CareWise - 800-292-2392
Provider Enrollment or Revalidation  - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890

Provider MCO Information

Anthem - (800) 205-5870 
Aetna Better Health of KY - (855) 300-5528 
Humana - (855) 852-7005
Passport Health Plan- (800) 578-0775
WellCare of KY - (877) 389-9457

Contact Information

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