Virginia Medicaid Hospice Billing Becomes RUG-based on July 1: From VHCA

Hospice Billing Changing to RUG-based on July 1

New Resource Utilization Group (RUG)-based payment rates for hospice providers will be used for dates of service beginning July 1, 2015.  The Virginia Health Care Association (VHCA) advises that nursing facilities may need to revisit their contract with hospice providers to ensure the contract language accommodates the reimbursement change.  Additionally, under the methodology change, the hospice providers will need to know the appropriate RUG assignment (to determine the rate) for both their billing to DMAS and their payment back to the nursing facility.  As such, a nursing facility will likely need to include the RUG information, in whatever form the parties agree, on communication to the hospice to ensure accurate and timely billing and payment.  VHCA provide additional details on these changes in our May 21 edition of CareConnection.

While primarily intended for hospice providers, DMAS has published a recorded WebEx session detailing billing instructions for hospice RUG-adjusted reimbursement effective July 1, 2015.  The recorded session can be accessed here – scroll to the Hospice RUG topic (currently first on the list).

Additionally, the Frequently Asked Questions (FAQs), posted on the DMAS website have been revised as of June 22, 2015 to reflect the new hospice requirements. You may send any questions related to rates and billing to NFPayment@dmas.virginia.gov.