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FAQ: When To Send A Hospice 81c?

What is a hospice election period?

3.1. An individual (or his authorized representative) must elect hospice care to receive it. The first election is for a 90-day period. An individual may elect to receive Medicare coverage for two 90-day periods, and an unlimited number of 60-day periods.

What does Hospice revocation mean?

A hospice revocation is a beneficiary’s choice to no longer receive Medicare covered hospice benefits. To revoke the election of hospice care, the beneficiary/representative must give a signed written statement of revocation to the hospice.

How is hospice billed?

Hospice providers are paid a per diem rate by Medicare to cover all daily costs of care for their patients. When hospice is elected, no other providers can bill, except under certain circumstances.

How do you bill a hospice physician?

When appropriate, physician/NP/PA services can be billed on an initial hospice claim (81X or 82X), along with the levels of care and discipline visits. If the physician/NP/PA services are not included on the initial hospice claim, an adjustment claim (817 or 827) can be submitted to add the services.

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What qualifies a patient for hospice?

When do patients qualify for hospice care? When determining eligibility for hospice, a doctor must certify that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its expected course. The hospice medical director must agree with the doctor’s assessment.

How long is a hospice benefit period?

Hospice care is given in benefit periods. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. A benefit period starts the day you begin to get hospice care, and it ends when your 90-day or 60-day benefit period ends.

What are the four levels of hospice care?

Four Levels of Hospice Care

  • Intermittent Home Care. Intermittent home care refers to routine care delivered through regularly scheduled visits.
  • Continuous Care. Hospice may also provide home nursing for hours at a time, and even overnight.
  • Inpatient Respite.
  • General Inpatient Care.

How Long Will Medicare pay for hospice care?

At the end of 6 months, Medicare will keep paying for hospice care if you need it. The hospice medical director or your doctor will need to meet with you in person, and then re-certify that life expectancy is still not longer than 6 months. Medicare will pay for two 90-day benefit periods.

Can hospice care be reversed?

Yes. Patients can choose to stop receiving hospice services without a doctor’s consent. It is called “revoking” hospice. Sometimes patients choose to discontinue hospice services because they want to give curative treatments another try.

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How Does Medicare pay for hospice?

Your costs in Original Medicare

You pay nothing for Hospice care. You pay a Copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn’t cover your drug, your hospice provider should contact your plan to see if Part D covers it.

What is the modifier for Hospice?

When the physician provide a service related to the hospice diagnosis for which the patient is enrolled, GV modifier is used. When the physician provides a service unrelated or not related to the hospice diagnosis for which the patient is enrolled, GW modifier is used.

How do hospice companies get paid?

Medicare pays hospice agencies a daily rate for each day a beneficiary is enrolled in the hospice benefit (Figure 1). Medicare makes a daily payment, regardless of the amount of services provided on a given day and on days when no services are provided.

Can you bill for hospice certification?

Certification/Recertification of Home Health Plans of Care

Physicians that oversee the complex care needs of Medicare home health and hospice patients can be reimbursed for these services. In addition, physicians can also bill for the services associated with certifying (and recertifying) home health services.

Can a nurse practitioner be an attending physician for Hospice?

When a physician refers a patient to hospice, we often see hospices obtaining the certification from this referring physician. The patient can choose a nurse practitioner as the attending physician, but the nurse practitioner cannot certify the patient.

How many medical directors can a hospice have?

There can be only one hospice medical director per hospice provider number; and. Either the medical director or a physician from the interdisciplinary team (“IDT”) may certify or recertify patients for terminal illness and eligibility for the Medicare hospice benefit.

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