HOSPICE RESIDENTS AND THE MEDICAID CASE-MIX

The Myers and Stauffer Help Desk has been receiving calls relating to residents who are on Hospice. To clarify which payor source is applicable for each resident, including Hospice residents, please determine the appropriate payor according to who is being billed for the Point in Time.

The first thing to note is the payor source decision should be made based upon the resident’s payor status in the facility as of the point in time date of the roster in question i.e. 3/31, 6/30, 9/30 or 12/31.

The second item to consider is who is being billed for that care on that particular date. This answer will determine the payor to be entered in the NC web portal relating to that roster. Please note that the payor source application can accept the following permutations Medicaid, Medicaid Pending, Medicare or Other and the appropriate value should be chosen in consultation with the Business Office staff.