Currentblue cross blue shield - michiganPolicy N/A

Hospice Care

Defines BCN Advantage (Blue Care Network Michigan) hospice benefit alignment with Medicare hospice coverage and describes enhanced member reimbursement for hospice coinsurance for applicable BCN Advantage plans.

Policy Summary

Payerblue cross blue shield - michigan

PolicyHospice Care

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionMembers or authorized representatives must submit reimbursement requests for hospice coinsurance to BCN with required documentation (MSN or receipts, member and contract information).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

coinsurance reimbursement offeredenhanced benefit for member coinsurance

6 monthsMedicare hospice eligibility criterion

5 daysrespite care max

01/01/2026policy effective date

BCN Advantageplan types

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Hospice coverage and reimbursement criteria

Coverage aligns with Original Medicare hospice benefit; BCN Advantage may provide enhanced reimbursement of member coinsurance for select BCN Advantage plans.

Coverage and reimbursement align with the Original Medicare hospice benefit and applicable BCN Advantage plan documents.

ALL of the following

Member must be entitled to Medicare Part A and have a terminal illness with a medical prognosis of life expectancy of six months or less if the illness runs its normal course.
The individual (or authorized representative) must file an election statement with a Medicare-certified hospice to receive hospice care.

ALL of the following

Medicare fee-for-service contractors retain payment responsibility for hospice services; Medicare processes hospice claims for members who elect hospice.
No payment is made to Blue Care Network on behalf of a BCN Advantage member who has elected hospice care; Original Medicare processes other non-hospice Part A/B services.

ALL of the following

Enhanced member reimbursement: BCN Advantage individual and select BCN Advantage group plans that include this enhanced benefit provide reimbursement to members for hospice coinsurance.
Reimbursement is provided to the member (not paid directly to hospice) because Medicare provides payment for hospice claims to fee-for-service contractors.

ALL of the following

To obtain reimbursement, the member or authorized representative must submit a reimbursement request to BCN with required documentation (member name, contract/group number, address, and Medicare Summary Notice or receipts).

ALL of the following

Medicare covers two levels of inpatient hospice care: respite (payment for respite care may not be provided for more than five consecutive days at a time) and general inpatient care for pain control and symptom management.

ALL of the following

Providers should verify member benefits and cost sharing via BCN provider resources and should obtain a BCN coverage determination before providing items or services that may be noncovered.

Billing, Verification, and Member Reimbursement Actions

Billing Rule

Billing and benefit verification — bill Medicare FFS and verify cost-share

Bill hospice claims to Medicare fee-for-service contractors (Medicare Administrative Contractors, Carriers, Fiscal Intermediaries, Regional Home Health Intermediaries, etc.) rather than to Blue Care Network; follow CMS Medicare Managed Care Manual, Chapter 8 §70.3.1 for payment guidelines. Verify member benefits and applicable cost-sharing before providing services using the BCN provider portal or by calling 1-800-344-8525. Obtain a BCN coverage determination before providing items that may be noncovered.

Medicare maintains payment responsibility for hospice services for BCN Advantage members who elect hospice; no payment is made to BCN on behalf of such members.
Providers should bill the appropriate Medicare fee-for-service contractor (e.g., Regional Home Health Intermediary) for hospice services.
Use the provider portal or call 1-800-344-8525 to verify benefits and cost-share.
If coverage is uncertain, seek a BCN coverage determination before providing noncovered items; do not have members sign an Advance Beneficiary Notice of Noncoverage to accept financial responsibility for noncovered items.

Documentation Required

Member reimbursement submission — submit MSN and member/contract info to BCN

Members or their authorized representatives must submit requests for reimbursement of hospice coinsurance to BCN with required member and claim documentation sent to the address provided for Member Reimbursements - G804.

Include member name, BCN Advantage contract and group number, and member address.
Provide a legible copy of the Medicare Summary Notice (MSN) from Original Medicare and/or receipts that verify the 5% coinsurance amount.
Mail the documentation to: Member Reimbursements - G804, Blue Care Network, P.O. Box 68753, Grand Rapids, MI 49516-8753.

Key Definitions

inv-05: Hospice care — definition

DefinitionHospice care provides medical, psychological, social and spiritual services to terminally ill patients and their families, with emphasis on pain control and emotional support.

Scope of servicesCare typically focuses on comfort and symptom management and generally does not include extraordinary measures to prolong life.

Care settingsServices are provided by Medicare‑certified hospices and may include home‑based and inpatient support (respite and general inpatient care).

Primary emphasisPain control, psychosocial and spiritual support for patients and families.

inv-06: Terminal illness — definition

DefinitionTerminal illness is when the medical prognosis estimates the individual's life expectancy is six months or less if the illness runs its normal course.

Medicare eligibility implicationMedicare beneficiaries with a terminal illness and life expectancy of six months or less may elect hospice benefits under Part A.

Election requirementAn individual or their authorized representative must file an election statement with a particular hospice to receive hospice care.

Certification requirementOnly care provided by a Medicare‑certified hospice is covered under the hospice benefit provision.

Policy Summary

Payerblue cross blue shield - michigan

PolicyHospice Care

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionMembers or authorized representatives must submit reimbursement requests for hospice coinsurance to BCN with required documentation (MSN or receipts, member and contract information).

SourceLink

On This Page

Not Applicable	No specific CPT/HCPCS codes listed.
Not Applicable	No specific ICD-10 codes listed.

OpenPayer

Hospice Care

Coverage and Eligibility

Billing Codes

Billing, Verification, and Member Reimbursement Actions

Key Definitions