Key Responsibilities

1. Medicare Hospice Billing

- Verify patient Medicare eligibility and hospice benefit coverage.
- Review hospice election and certification information prior to billing.
- Submit and monitor Notice of Election (NOE) transactions.
- Submit Notice of Termination/Revocation (NOTR) when applicable.
- Prepare and submit Medicare hospice claims according to CMS billing requirements.
- Understand hospice levels of care, including:

- Routine Home Care (RHC)

- Continuous Home Care (CHC)

- Inpatient Respite Care (IRC)

- General Inpatient Care (GIP)
- Review patient status, dates of service, level of care, units, revenue codes, and other required claim information.
- Work Medicare claim rejections and RTP (Return to Provider) claims.
- Correct and resubmit claims when required.
- Review Medicare remittance advice and identify underpayments, denials, and payment discrepancies.
- Handle adjustments, cancellations, and corrected claims.
- Follow up on outstanding Medicare accounts receivable.
- Maintain documentation supporting billing and audit requirements.

1. EVV Billing & Compliance

- Review Electronic Visit Verification records before submitting claims for EVV-required services.
- Verify that required visits have valid:

- Date of service

- Start and end time

- Member/patient information

- Caregiver information

- Service provided
- Location or other required verification information
- Identify missing, incomplete, unmatched, or rejected EVV records.
- Coordinate with clinical, scheduling, and operations teams to correct EVV discrepancies.
- Verify that EVV information successfully reaches the applicable state Medicaid or payer system when required.
- Reconcile EVV records against billed units and claims.
- Investigate EVV-related claim denials and recoupments.




- Correct EVV validation issues before claim resubmission whenever possible.
- Maintain knowledge of state Medicaid and Managed Care Organization (MCO) EVV requirements.
- Track recurring EVV errors and communicate compliance issues to management.

1. Hospice Room & • Board Billing

- Identify hospice patients residing in nursing facilities or other applicable institutional settings.
- Verify Medicaid eligibility and payer responsibility for Room & • Board.

- Review patient hospice status and facility information before billing.
- Prepare and submit Room & • Board claims to Medicaid or the appropriate Medicaid Managed Care payer according to applicable payer requirements.

- Verify dates of service and facility stay information.
- Coordinate with Skilled Nursing Facilities (SNFs), Nursing Facilities (NFs), hospice staff, and payer representatives regarding Room & • Board billing issues.

- Reconcile Room & • Board payments against expected reimbursement.

- Identify patient liability/share-of-cost amounts where applicable.
- Research unpaid, rejected, or denied Room & • Board claims.

- Correct and resubmit claims as required.
- Follow up with Medicaid/MCOs regarding outstanding claims.
- Maintain accurate records of billed, paid, denied, adjusted, and outstanding Room & • Board claims.

Denial & • Accounts Receivable Management The Biller will be responsible for investigating and resolving denials involving:
- Eligibility and coverage
- Authorization
- EVV validation
- Duplicate claims
- Timely filing
- Coordination of Perks (COB)
- Other payer coverage
- Incorrect patient/member information
- Incorrect dates, units, revenue codes, or claim information
- Missing documentation
- Room & Board eligibility/payment issues
- Medicare hospice billing errors
- Claim recoupments and take-backs

📌 Medicare Hospice, EVV & Medicaid Room and Board Biller (New Delhi)
🏢 REVENUE HEALTH
📍 New Delhi