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Hospice Medicaid Room & Board Pass-Through Billing

Medicaid, which differs from state to state, enacted a rule that when hospice patients are housed in a facility such as a skilled nursing facility, the hospice agency bills Medicaid for the facility’s room and board daily rate. Medicaid then pays the hospice agency the lump sum of room and board money minus a 5% deduction. The hospice agency is responsible for paying the room & board billing to the facility; forced by Medicaid into acting as a middleman.

This mandate requires the hospice to do a significant amount of work that is not to their benefit, costs the agency 5% of the R&B billing for the pleasure of doing all this work and even worse, puts the whole responsibility for billing, collecting, and paying those funds on the backs of the agency .

Pitfalls of Pass Through Room & Board Billing Workflows:
  1. Each SNF can have a different room and board billing rates, which means there is no standardization. Your agency needs tracking systems for the billing of every facility your agency deals with. And because most EMR & billing systems aren’t equipped to deal with this issue, your agency will struggle using spreadsheets or, on top of the already expensive software, billing fees, and 5% Medicaid deduction, your agency must now pay even more money for 3rd party add-on software?!?!?!
  2. If the SNF billers are slow to send their invoices to the hospice, it delays when the hospice agency gets paid and when the SNF gets reimbursed. Slow invoicing ties up cash flow unnecessarily and deeply impacts the relationship with your referral source. The admin of the SNF doesn’t care why, they want their money and they want it now. In fact, many SNF<>Hospice Agency contracts will call for the SNF to be reimbursed within 30 or 60 days regardless of when the hospice receives the funds.  If you’re regularly late paying the SNF their room & board billing, watch how quickly your referral source dries up.
  3. Labor costs. Hospice agency billers who are using spreadsheets to track and organize AR spend an inordinate amount of time and energy managing a bad an inefficient system that is of little to no benefit to your agency. The same is true if you’re using a billing company, the costs for managing these payments is simply more money with no benefit.
  4. The lack of standardization means even when nursing home billers send invoices for room and board to the hospice in a timely fashion, the cumbersome and confusing workflow virtually guarantees delays and errors.

We know these issues because we had these same problems. Hospice Tools was built by hospice & palliative pros who had enough. We were so fed up with the cumbersome legacy EMR that cost a fortune, weren’t truly designed from the ground up for hospice, and worse, had terrible support.

We decided to build a system dedicated to hospice & palliative agencies by people who actually know the issues affecting hospice agencies – including handling Medicaid pass-through billing, with tools that are simple, fast, efficient, powerful, and affordable. 

Hospice Tools Medicaid Room & Board Solutions:
  1. Our powerful eDocs EMR tracks your patient current location using easy Master Lists of facilities and caregivers’ addresses. With the click of a button you can move patient locations. The daily census changes are tracked and easily accessible so your team can always see any patient changes. These census changes flow directly into our eBilling RCM software, so the exact amount of days and locations are perfectly captured without extra effort or spreadsheets.
  2. Hospice Tools stores and calculates all of the pass-through billing rates of each facility. When the daily census calculates the days at a Medicaid room and board facility the sums are virtually automatic; no calculators, spreadsheets, or equations needed.
  3. We automatically factor these pass-through billings in your receivables and payables reports. And, we can customize reports as needed for pass through room and board billing for granular access with the click of a button to a cleanly organized AR/AP.
  4. Hospice Tools helps hospices tightly track and organize their AR/AP so hospice agencies don’t overpay facilities. eBilling RCM tracks the Hospices collections from Medicaid and the room and board paid to SNFs providing a clear reconciliation of what is collected from Medicaid compared to what is paid to the SNF
  5. Hospice Tools eBilling RCM maintains easy entry and tracking of patient Medicaid liability. This means that for Medicaid patients who have a monthly flat amount that is their responsibility (Patient liability) to pay to the SNF, the hospice doesn’t collect or pay that portion to the SNF – rather the SNF is required to collect it directly from the patient. When the monthly billing is run, eBilling automatically generates a separate line item adjustment for the patient liability. This way, the AR you expect to collect is accurate and not overstated. The amount you pay the SNF does not include the patient liability so your agency can accurately and easily deduct that line item amount from your payment to the SNF.
  6. Service Service Service.

That is our commitment to our partners. It’s why your patients choose your agency; your commitment to service. As hospice pros we know what that means and it’s a critical value we bring to Hospice agencies and Revenue Cycle Management.

For example, our HT Pro Billers create and maintain relationships with the finance dept. in the SNFs that your hospice services. This ensures getting invoices and pass through data promptly and expedites the process.

Compare Solutions:

Hospice Tools eBilling Medicaid R&B Benefits:
  • Stop risking relationships with your referral sources
  • Stop paying even more for 3rd party room and board tracking software (really – pay even more??!?!)
  • Stop tying up staff using spreadsheets and waste your teams’ time and energy
  • Stop worrying about or not even knowing if you’re overpaying SNFs by not having an organized AR/AP that auto adjusts line item deductions

We know hospice. We know what you need. And we’re committed to delivering powerful, affordable solutions and unparalleled service.

Book Your Hospice Tools EMR Demo Today!
  • Seamless Scheduling
  • Professional Credential Storage
  • Automatic HIS
  • Super-Fast IDG 
  • Smart Care Plans
  • Automatic Compliance: Auto Build, Audit Mode, Mentor Mode
  • Comprehensive Hospice Care & Operations & Billing Reporting
  • Palliative Charting & Billing
  • Hospice Billing with Medicaid Room & Board Pass Through Rates Tracking
  • and more!

Built from the ground up by hospice & palliative pros, Hospice Tools delivers super fast charting, improved compliance, & maximized RCM.

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Built for hospice & palliative agencies, Hospice Tools EMR delivers a competitive advantage & peace of mind.

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