HOSPICE Pricer Program

130 HOSPICE Pricer Program (Rev. 3930; Issued: 12-01-17, Effective: 03-01-18, Implementation: 03-01-18) Hospice services billed on TOB 081x and 082x are reimbursed based on calculations made by the Hospice Pricer. The Hospice Pricer is a module within Medicare claims processing systems. The Hospice Pricer makes all payment calculations applicable under Hospice claims, including all levels of care (Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care). Medicare claims processing systems must send an input record to Pricer for all claims with covered visits, and Pricer will return an output record to the shared systems. The following section describes the elements of Hospice claims that are used in the Hospice Pricer and the logic that is used to make payment determinations. The following is presented for A/B MACs (HHH) in order to help understand their Hospice payments and how they are determined.