Navigating Medicaid Room and Board Billing for Hospice

Billing Medicaid for room and board for hospice patients in nursing facilities is one of the most complex and often overlooked areas of hospice billing.

Understanding Room and Board

When a hospice patient resides in a nursing facility, the hospice is responsible for the patient overall plan of care. However, Medicaid should cover room and board costs separately from the Medicare hospice benefit.

Step-by-Step Process

1. Verify Medicaid eligibility for the patient
2. Determine the appropriate rate based on state Medicaid guidelines
3. Submit claims to Medicaid with proper coding
4. Coordinate with the nursing facility for billing alignment
5. Follow up on denials promptly

Common Pitfalls

• Not billing Medicaid at all (many agencies miss this entirely)
• Using incorrect rate codes for the state
• Failing to follow up on denied claims
• Not coordinating with the nursing facility billing department

CPS Medical Billing handles Medicaid room and board billing for hospice agencies across multiple states, ensuring no revenue is left uncollected.