Starting @2.95% Of Monthly Collections

Hospice billing often feels like navigating a maze of codes, payer rules, and strict compliance requirements. Every detail matters – from diagnosis coding to the correct use of revenue codes. Among these, Revenue Code 0115 plays a crucial role in ensuring accurate reimbursement for hospice services delivered in nursing facilities.

At Armored MBS, we understand that even a single billing error can delay payments, cause denials, and disrupt your revenue cycle. That’s why our team emphasizes mastering foundational billing codes like 0115. In this detailed guide, we’ll explain what Revenue Code 0115 means, when to use it, how to bill it correctly, and how to avoid common claim issues.

Whether you’re a hospice biller, provider, or healthcare administrator, this article will give you a step-by-step understanding of Revenue Code 0115 and how it fits into the broader hospice billing process.

What Is Revenue Code 0115?

Revenue Code 0115 belongs to the series of codes used to describe room and board services on the UB-04 (CMS-1450) billing form. Specifically, it refers to:

0115 – Hospice – Room and Board (Routine Home Care)

Hospice agencies use this code when billing for routine home care provided in a nursing facility. This means when a hospice patient resides in a Skilled Nursing Facility (SNF), assisted living, or another long-term care setting, the hospice bills Medicare or other payers under Revenue Code 0115 for the room and board portion of care.

The hospice agency receives payment from the payer (for instance, Medicare) and then pays the facility a contracted per diem rate for room and board.

In other words, 0115 bridges the financial relationship between the hospice provider and the nursing facility, ensuring both are reimbursed appropriately for their respective roles in the patient’s care.

Why Revenue Code 0115 Matters in Hospice Billing

Revenue Code 0115 is far more than a line item; it’s a key compliance and reimbursement component within the hospice billing structure. When applied correctly, it ensures:

• Accurate Medicare or Medicaid reimbursement
• Compliance with payer billing requirements
• Proper reflection of the patient’s care setting
• Prevention of claim denials and audit exposure

Using the wrong revenue code or omitting 0115 altogether can lead to payment delays, claim denials, or even recoupments after an audit. Because hospice claims often involve multiple levels of care and different payer sources, precision in coding is absolutely essential.

At Armored MBS, our billing specialists carefully review hospice claims for accurate revenue code usage, ensuring each submission meets payer-specific criteria and CMS standards.

Revenue Code 0115 and the Medicare Hospice Benefit

Under the Medicare Hospice Benefit, when a hospice patient lives in a nursing facility, the hospice agency is responsible for managing the patient’s plan of care including pain management, symptom control, and coordination with facility staff.

In these cases, Medicare does not reimburse the nursing facility directly for room and board. Instead:

1. The hospice agency bills Medicare using Revenue Code 0115.
2. Medicare reimburses the hospice agency at the approved daily rate.
3. The hospice then pays the nursing facility a contracted per diem for room and board.

This setup ensures that hospices maintain clinical and financial responsibility for the patient’s care, while facilities receive compensation for the accommodation and basic services they provide.

Because 0115 is central to this transaction, any mistake such as missing units, incorrect service dates, or a wrong revenue code can halt payment altogether.

Common Hospice Revenue Codes

Hospice billing involves several revenue codes depending on the level of care provided. Here’s a quick overview:

While the 065X series is commonly used for most hospice services, 0115 is unique. It is only used when a patient receives routine hospice care while residing in a nursing facility.

For example:

• Use 0651 – when the patient receives care in their home.
• Use 0115 – when the patient receives routine hospice care in a facility.

This distinction is critical and it’s one of the most common sources of confusion for hospice billers.

How to Bill Hospice Claims Using Revenue Code 0115

Accurate billing of hospice claims with Revenue Code 0115 requires careful alignment between revenue codes, HCPCS codes, and payer rules. Here’s a step-by-step process:

Step 1: Verify the Patient’s Setting

Confirm that the hospice patient resides in a nursing facility, assisted living, or long-term care center. Revenue Code 0115 only applies in these environments.

Step 2: Use the UB-04 Claim Form

Hospice claims are billed on the UB-04 (CMS-1450) form. Enter revenue codes in Form Locator 42 and list corresponding charges and service units.

Step 3: Enter Revenue Code 0115

In Form Locator 42, enter 0115 to represent room and board for hospice services in a facility.

Step 4: Record Room and Board Charges

Report the daily charge agreed upon in your contract with the facility. Multiply the per-day rate by the total number of service days.

Step 5: Include Accurate Service Units and Dates

Make sure the units (days of care) and dates of service match precisely across the claim. Even one mismatch can trigger a denial.

Step 6: Add Applicable HCPCS Codes

Pair 0115 with any necessary HCPCS codes that describe the type or level of care. Accuracy here reinforces claim integrity.

Step 7: Submit to the Correct Payer

For Medicare patients, send the claim to the Medicare Administrative Contractor (MAC). For Medicaid or commercial payers, follow their specific claim guidelines.

At Armored MBS, we use advanced billing software and manual verification to ensure every hospice claim with 0115 meets payer specifications before submission.

Common Billing Errors with Revenue Code 0115

Even experienced hospice billers can make small mistakes that lead to major denials. Some of the most frequent errors include:

• Using 0651 instead of 0115 for facility patients
• Incorrect or missing service dates
• Mismatched service units across revenue and HCPCS lines
• Billing Medicaid before Medicare in dual-eligible cases
• Missing or incomplete supporting documentation

Each of these issues can result in denials, payment delays, or compliance flags. Armored MBS’s claim auditing and denial management process identifies such errors early before they reach the payer.

Common Denial Codes for Hospice Claims

When claims involving Revenue Code 0115 are denied, payers typically return specific denial or remark codes that help identify the issue:

For example, if a hospice accidentally uses 0651 instead of 0115 for a facility patient, Medicare may issue Denial Code 176, indicating an invalid revenue code.

How to Avoid Denials and Ensure Compliance

To maintain clean claims and efficient cash flow, Armored MBS recommends the following best practices for hospice billing:

• Train billing staff regularly on hospice revenue codes and payer-specific policies.
• Maintain accurate facility contracts detailing per-diem room and board rates.
• Audit hospice claims monthly to identify coding patterns or recurring errors.
• Use claim scrubbers or EHR-integrated tools that flag missing revenue codes.
• Stay updated on CMS hospice billing guidelines and MAC bulletins.

Accurate hospice billing isn’t just about faster reimbursement it’s about compliance, integrity, and financial stability for your organization.

Real-World Example: Correct Use of Revenue Code 0115

Patient: Mrs. J
Setting: Skilled Nursing Facility
Payer: Medicare Part A
Dates of Service: 10/01/2025 – 10/07/2025

Mrs. J is a hospice patient receiving routine home care in a SNF. The hospice bills as follows:

• Revenue Code: 0115
• Units: 7
• Per Diem Rate: $250
• Total Charges: $1,750

Because the code, dates, and units align correctly, Medicare reimburses the hospice without denial. The hospice then pays the facility based on the agreed per-diem contract.

This case illustrates how accurate use of Revenue Code 0115 ensures proper payment flow and minimizes administrative follow-up.

Why Choose Armored MBS for Hospice Billing Accuracy

Hospice billing requires precision, and even minor coding errors can lead to substantial financial loss. Armored MBS is your trusted partner for comprehensive hospice billing and revenue cycle management, providing:

• Accurate use of revenue codes like 0115
• Clean claim submission and timely follow-up
• Denial prevention and appeals management
• Compliance monitoring aligned with Medicare and Medicaid rules

Our billing specialists bring years of hospice-specific experience to every claim. We don’t just process claims, we protect your revenue, ensure compliance, and empower your agency to focus on compassionate patient care.

Conclusion

Revenue Code 0115 is vital for accurate hospice billing, particularly for patients receiving routine home care in nursing facilities. Understanding how and when to use it ensures smooth reimbursement, regulatory compliance, and financial stability.

By mastering Revenue Code 0115 and partnering with experts like Armored MBS, hospice agencies can eliminate costly denials, streamline their billing process, and focus on what truly matters, providing quality end-of-life care.

Frequently Asked Questions (FAQs)

1. What is Revenue Code 0115 in hospice billing?

Revenue Code 0115 is used to bill room and board charges for hospice patients living in a nursing facility. It represents “Routine Home Care – Room and Board” and is required for proper reimbursement under the Medicare Hospice Benefit.

2. When should hospice providers use Revenue Code 0115?

Use Revenue Code 0115 when a patient is receiving routine hospice care in a Skilled Nursing Facility or long-term care setting. Do not use it for care provided at home or inpatient hospice centers.

3. How do you bill Medicare for Revenue Code 0115?

Hospices must use the UB-04 claim form, enter 0115 in the revenue code field, list the daily room and board charges, accurately record service units and dates, and submit to the Medicare Administrative Contractor (MAC).

4. What are common denial reasons for Revenue Code 0115 claims?

• Wrong revenue code (e.g., using 0651 instead of 0115)
• Missing or mismatched dates of service
• Incorrect payer sequencing
• Missing or incomplete documentation

These often generate Denial Code 176 or M76 remark codes.

5. What is the difference between Revenue Code 0115 and 0651?

The difference lies in the care setting:

• 0115 – Hospice room and board in a nursing facility
• 0651 – Routine home care in the patient’s residence

Using the correct code ensures accurate reimbursement and compliance.