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Medicare Hospice Benefit

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Presentation on theme: "Medicare Hospice Benefit"— Presentation transcript:

1 Medicare Hospice Benefit
Alice Emery MD Hospice of Michigan 989 Spaulding SE, Ada, MI Cell (616)

2 Medicare Hospice Benefit
Who is eligible for hospice care What services are included What regulations must Hospices follow Questions

3 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 illness. Certification period initially 90 days Doctor must by MD or DO, not NP or PA to certify

4 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

5 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. NP cannot certify terminality

6 Medicare Hospice Benefit
Levels of care covered: Routine homecare General Inpatient Continuous homecare Respite care

7 Question: 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? Cannot admit to hospital as GIP as the “Caregiver Breakdown” clause is not allowable anymore. Cannot do continuous care either as no need. Respite at SNF or go home with dau.

8 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

9 Medicare Hospice Benefit
F2F for Recertification: 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 required. 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 recertification. Nonbillable

10 Question: 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? Patient remains on svc and F2F is completed as soon as you are able. Patient is discharged from svc & readmitted once F2F completed Patient is discharged and not readmitted Physician notes why unable to complete visit and makes sure to complete next F2F prior to next benefit period. B. – Must discharge patient because all eligibility criteria have not been met for recertification. In this case (assuming pt is medically and philosophically eligible) the criterion not met is lack of F2F visit. Note: this is a burden on the patient, pt’s caregivers and hospice staff who will likely continue to care for the patient (free of charge) and go through entire readmission process once F2F visit is completed.

11 Question: 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? Day 1 of admission Day 1-15 Before Day 80 Before Day 180 Day 1 of admission

12 Question: 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? Allow to continue and hospice pay for Keppra. Allow them to continue Keppra patient pay. Tell them they “have to” switch to dilantin. A or C

13 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.

14 Question: 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? Hospice pays

15 Question: 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? Revoke/discharge from hospice Transfer to a local Ky hospice Air lift patient back to Michigan Hospice pays for admission and discharge pt as soon as possible.

16 Question: 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? Depends if pathological fracture then hospice pays, if normal bone, MA pays

17 Question: 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 trip. Is that a revocation or a discharge? Revocation

18 Reference Hospice Conditions of Participation
Guidance/Guidance/Manuals/downloads/som10 7ap_m_hospice.pdf

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