Medicare Hospice Benefit

Medicare Hospice Benefit
Alice Emery MD
Hospice of Michigan
989 Spaulding SE, Ada, MI
[email protected]
Cell (616) 322-8461
Medicare Hospice Benefit
1. Who is eligible for hospice care
2. What services are included
3. What regulations must Hospices
4. Questions
Medicare Hospice Benefit
 Eligibility: for Medicare Part A benefits
 Patient with 2 doctors to certify terminal
illness that if allowed to follow it’s natural
course would result in prognosis of “six
months or less.”
 Sign a statement choosing Hospice benefit
over other Medicare part A benefits for this
 Certification period initially 90 days
Medicare Hospice Benefit
 Initial certification: 90, 90, then 60 thereafter
 Need verbal cert within 2 calendar days of
starting services (by the end of third day) and
then complete written certifications
 For subsequent certifications must have
physician’s written cert no more than 15 days
prior or 2 days after the re-certification date
Medicare Hospice Benefit
 Pre-hospice Consult may be provided by a
hospice doctor (employee of a Hospice). This
is only paid when/if the patient elects
hospice. Must meet several criteria:
 Pt has never been on hospice before or had a
pre hospice consult before
 Physician does not write prescriptions for pt
 Cannot have other physician services from
same Dr same day.
Medicare Hospice Benefit
Levels of care covered:
 Routine homecare
 General Inpatient
 Continuous homecare
 Respite care
 Mrs C has dementia and is cared for by her
husband in their home. Mr C has a heart
attack and is admitted to the hospital.
Their daughter wants Mrs C admitted to the
hospital for care while her Dad is hospitalized.
Can the patient be admitted?
Would this be routine homecare, respite, or
GIP level of care?
What else could be done?
Medicare Hospice Benefit
 Nursing
 Aide/homemaker
 Social worker
 Spiritual care and counseling
 Speech/OT/PT or other therapies related to TI
 volunteers
 *Physician oversight
 Bereavement services
Medicare Hospice Benefit
 F2F for Recertification: 2-90 day periods then
unlimited 60. Prior to entering the third benefit
period, a Face to Face Encounter with a
physician (or NP) employed by the hospice is
 Every recertification thereafter a Face to Face
Encounter is required prior to the start of new
benefit period.
 May be completed up to 30 days prior to
 Nonbillable
You are the hospice medical director assigned to
complete Mrs. Q’s F2F visit, but you don’t complete
it until after the start of the 3rd benefit period (after
day 180). What happens next?
A. Patient remains on svc and F2F is completed as
soon as you are able.
B. Patient is discharged from svc & readmitted
once F2F completed
C. Patient is discharged and not readmitted
D. Physician notes why unable to complete visit
and makes sure to complete next F2F prior to
next benefit period.
Mrs Q has been on hospice in Florida for 100
days for CHF. She moves to Michigan to live
with her daughter. She signs on to your
hospice, when do you need to do F2F?
A. Day 1 of admission
B. Day 1-15
C. Before Day 80
D. Before Day 180
Mr B has been taking keppra to prevent seizures
from his brain tumors. Keppra is expensive, and
not on your formulary. Pharmacy suggests
dilantin, but Mr and Mrs B are afraid to switch.
Which of these options is NOT an allowable
policy decision?
A. Allow to continue and hospice pay for
B. Allow them to continue Keppra patient pay.
C. Tell them they “have to” switch to dilantin.
Medicare Hospice Benefit
Hospice will provide all
 Medications
 Equipment
 Services
Needed for comfort care of patient’s terminal
illness as determined by the care team. The
care team is responsible for plan of care.
Mr N has end stage COPD. His brother comes
to visit and calls 911 when Mr N gets dyspneic.
Mr N is treated with an albuterol treatment in
the ER (which he had at home) and returns to
his apartment.
Who pays for the ER visit?
Mrs S. plans a weekend visit to family in
Tennessee. She has a pain crisis in Kentucky
and is hospitalized in Lexington. She is still an
active patient on your service.
 Who pays for the admission?
 What do you do next since you cannot
provide care in Kentucky?
A. Revoke/discharge from hospice
B. Transfer to a local Ky hospice
C. Air lift patient back to Michigan
Mrs W has multiple myeloma with several
painful areas of bone. She falls and femur is
found to be fractured. She is hospitalized.
She elects surgical repair of the hip…
 Who pays for the surgery?
 Is it related or unrelated?
 Is it comfort care or aggressive care?
Mrs D finds a new treatment for her end stage
cancer available in Mexico. She decides to
travel to Mexico to try it. Your team advises
against it. She signs off your hospice for the
 Is that a revocation or a discharge?
 Hospice Conditions of Participation

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