Crossover Claims and Hospice Care

Crossover Claims and Hospice Care

MHD implemented a system change on June 20, 2026. The system change is to identify Crossover claims for participants who are in a Part C Medicare plan and have been in the Hospice part of the month. With this system change, these crossover claims will no longer be denied, and providers will no longer have to fax or call the Medicare unit for assistance in getting their claims paid.  

Please contact the Medicare unit at 573 751-9312 for any questions pertaining to this change in the system.

PACE Benefit Table

Program of All-Inclusive Care for the Elderly (PACE) Benefit Table

The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.

Re-Pricing Medicare Inpatient Hospital Claims

Since July 1, 1991, the MO HealthNet Division (MHD) has been re-pricing Medicare Part A inpatient hospital crossover claims for the possible payment of Medicare deductible and co-insurance amounts. This Hot Tip is a reminder that the re-pricing policy also applies to Medicare Part C/Advantage plans for inpatient hospital services for deductible, co-insurance and co-pay amounts for participants who are QMB eligible.

Reporting Sequestration for Medicare Part C Plans

On April 1, 2013, The Centers for Medicare and Medicaid Services (CMS) imposed a mandatory 2% reduction in the Medicare Fee-for-Service (FFS) Program, also known as “Sequestration.”  Sequestration reductions were reflected on the Medicare Explanation of Benefits (EOB) as Claim Adjustment Reason Code (CARC) number 223.  This action affects FFS claims with dates of service or dates of discharge on or after April 1, 2013. 

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