Accurate billing and coding are paramount for hospice facilities to ensure timely and appropriate reimbursement. As 2025 brings new challenges and updates, understanding the correct application of specific hospice revenue codes, particularly 0651, 0658, and 0659, is critical. This comprehensive guide will walk medical billers, coders, and hospice providers through the essential guidelines for facility hospice claim billing, with a focus on Medicare and Medicaid requirements, common challenges, and best practices.
Understanding Hospice Revenue Codes for 2025
Hospice care is billed using specific revenue codes on the UB-04 claim form to categorize the type of service provided. These codes distinguish between different levels of care, ensuring payers understand the nature of the services rendered. Failure to use the correct hospice rev code can lead to claim denials and payment delays. Let’s delve into the most common and queried hospice revenue codes.
Revenue Code 0651: Routine Home Care (RHC)
Revenue code 0651 is used for routine home care, which is the most common level of hospice care. This service provides professional and other services to the patient in their home, and payment is made at a daily rate regardless of the volume of services provided on a given day. Billing guidelines for hospice revenue code 0651 require careful attention to the patient’s location and eligibility. Understanding Medicare 0651 Billing Guidelines is crucial, as this code often goes to a standard billing rate when conditions are met.
A common query, “claim line revenue code 0651 requires submission of a HCPCS code,” highlights the importance of linking appropriate procedure codes (HCPCS) when specific services are provided that fall outside the daily rate, or when required by a specific payer policy. Always verify payer-specific rules.
Revenue Code 0652: Continuous Home Care (CHC)
Revenue code 0652 signifies continuous home care, which is provided during periods of crisis to maintain the patient at home. This care is predominantly nursing care, supplemented with homemaker or hospice aide services, and must meet minimum hour requirements. It’s billed on an hourly basis.
Revenue Code 0655: Inpatient Respite Care
This code is used for short-term inpatient care provided to the patient in an approved facility to relieve the family or primary caregiver. Respite care is limited by days per benefit period and typically has specific billing intervals.
Revenue Code 0656: General Inpatient Care (GIP)
Revenue code 0656 represents general inpatient care, which is provided in an inpatient facility (e.g., hospital, hospice inpatient unit) for pain control or acute symptom management that cannot be managed in other settings. This is a higher level of care and requires meticulous documentation to justify the inpatient stay.
Revenue Code 0658: Residential Hospice Care
Revenue code 0658 is designated for residential hospice care, specifically when the hospice agency operates its own inpatient facility. This is often misunderstood, leading to questions like “what is the 658 rev codes” and confusion with other inpatient codes. It applies to facilities licensed to provide 24-hour skilled nursing and related services. Billing for hospice revenue code 0658 requires strict adherence to state and federal regulations, particularly for Medicaid 0658 claims, which can have varying requirements. This code is critical for facilities providing a structured residential setting for hospice patients.
Revenue Code 0659: Hospice Other/Unknown
Rev code 0659 is a catch-all code used for hospice services that do not fit into the other specific categories. It’s less common but important for unique situations. Queries such as “is hospice 0659 revenue code billed under outpatient or inpatient Indiana Medicaid” highlight the need for payer-specific clarification, as its application can vary significantly by state Medicaid programs and the nature of the service. Sometimes, hospice 651 & 659 needs to be billed together for specific scenarios, requiring careful review of individual claim instructions.
Payer-Specific Guidelines: Medicare and Medicaid
Both Medicare and Medicaid have detailed guidelines for hospice billing. Medicare typically pays hospice providers a per diem rate for each of the four levels of care (RHC, CHC, Inpatient Respite, GIP). Medicaid rules can vary significantly by state, impacting how revenue codes like 0651 revenue code and revenue code 658 are reimbursed, and whether services are considered inpatient or outpatient for specific contexts. Always consult official CMS guidelines and your state’s Medicaid manual for precise instructions.
Addressing Common Billing Challenges and Denials
Hospice billing is complex, and errors can lead to denials. Common issues include:
- “Routine revenue code 0651 is invalid”: This denial often occurs if the claim lacks proper supporting documentation, the patient’s eligibility is incorrect, or if the dates of service do not align with certified periods.
- “Claim line revenue code 0651 requires submission of a HCPCS code”: While RHC is typically a per diem, some payers may require HCPCS codes for specific adjunct services or for tracking purposes. Always check payer guidelines and ensure any required HCPCS codes are included on the claim line.
- Incorrect Level of Care Assignment: Billing for a higher level of care (e.g., GIP) without sufficient documentation of medical necessity.
- Missing or Inaccurate Certifications: Failure to obtain or properly document initial and subsequent certifications of terminal illness.
To avoid these, ensure accurate patient status, comprehensive documentation, and strict adherence to payer guidelines. For more general solutions, refer to our guide on common denial reasons.
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