When the patient enters hospice care, the main goal of the healthcare center and doctors is to make the patient feel comfortable and help them with emotional support. It helps patients who are going through severe illness. The billing system of hospice care is also different from the normal medical treatment. Different billing codes are used to inform the insurance companies which services are provided to the patients. Revenue Code 0115 is one of them, which is used when the patient gets hospice care in a private room.
What Is Revenue Code 0115?
Revenue Code 0115 is a code that is used for the hospice inpatient care in a private room. It is a part of the 011X revenue code family. Every revenue code in this group indicates different types of rooms, like 0111 is used for a standard private room, 0113 is used for children staying in a private room, and 0115 is used for a hospice private room. Revenue code 0115 helps the insurance companies to understand what they are paying for. This is especially important in Medical billing services provided by Docvaz.
Which Services Are Covered Under Revenue Code 0115?
The services which revenue code 0115 includes:
- The private room in which the patient stays without sharing it with any other patient.
- Facility of the bed and other necessities available in the room.
- Regular meals, which are prepared by the medical dietary department.
- Daily nursing services for patients provide regular care.
- Services for maintenance and cleanliness of the room.
- Usual supplies used in the room, like towels or bed sheets.
Which Services Are Not Included In Revenue Code 0115?
There are some services that are not covered under revenue code 0115 and should be billed separately. These services include:
- Different laboratory tests, such as a blood test or any disease test, have their own billing codes.
- Imaging services, like X-rays or MRIs, are not included in revenue code 0115.
- Different therapies are billed by using their own billing codes.
- Medicines or drugs that are related to patients’ treatment.
When Should Revenue Code 0115 Be Used?
Revenue Code 0115 should be used when it meets the following conditions:
- The patient is getting hospice care.
- The patient is admitted to a private room.
- The hospital is billing for the daily room and services provided in the room.
- The patient is not getting hospice care nor daily medical treatment because, for regular medical treatment, a different billing code is used.
What Is Hospice Inpatient Care?
Hospice inpatient care is provided to patients when they are going through severe illness and need continuous medical attention. The main goal of hospice inpatient care is to provide emotional support and family support. Hospice care focuses more on the comfort of the patient than providing them treatment to cure their illness.
How To Use Revenue Code 0115 Correctly?
For the right use of revenue code 0115, the following steps should be followed:
Step 1: Ensure Hospice Care Eligibility
The first step is to confirm whether the patient is eligible for hospice care or not. For this, a signed hospice form is required and a certificate that the life expectancy of the patient is 7 months of less than it is needed. Without these documents, the claim may be rejected.
Step 2: Check The Insurance Company Billing Rules
Every insurance company has its own billing rules. Some need the 0656 revenue code for hospice care, and some need the 0115 revenue code. Therefore, always check the policies of the payer before submitting claims.
Step 3: Complete UB-04 Form
When the revenue code 0115 is used for billing, the UB-04 claim form should be filled with the right information. The important sections on the form include:
FL 42 – Revenue Code
In this, the staff writes the correct billing code, which tells the insurance company what they are paying for.
FL 45 – Service Date
This section tells on which dates the patient stayed in the private room.
FL 46 – Units
This section tells about the number of days the patient spends in the hospice room.
FL 6 – Statement Coverage Period
This section tells about the start date and the end date of the patient’s stay in the private room.
FAQ’s
Which services does revenue code 0115 include?
It includes the services, like a private room itself, a bed available in the rooms, daily monitoring, nursing care, and usual supplies.
Does revenue code 0115 include laboratory tests?
No, revenue code 0115 does not cover the laboratory tests of any other imaging services, for these different billing codes are used.
How can medical centers avoid hospice billing errors?
Healthcare centers can reduce the errors that occur in hospice billing by checking the insurance companies' rules and policies before billing, using the right billing code, giving accurate and complete documents, and checking the eligibility of the patients before submitting a claim.