What is Hospice?
Hospice is a program of care and support for people who are terminally
ill. It is available as a benefit under Medicare Hospital Insurance (Part
A). The focus of hospice is on care, not treatment or curing an
illness. Emphasis is placed on helping
people who are terminally ill live
comfortably by providing comfort and relief from pain. Some
important facts about hospice are:
** A specially trained team of
professionals and caregivers provide care
for the “whole person”, including his or her physical,
emotional, social and spiritual needs.
** Services may include physical care, counseling, drugs, equipment, and
supplies for terminal illness and related condition(s).
** Care is generally provided in the home.
** Hospice isn’t only for people with cancer.
** Family caregivers can get support.
When all the requirements are met, the Medicare hospice benefit includes:
** Physician and nursing services
** Medical equipment and supplies
** Outpatient drugs or biological for pain relief and symptom management
** Hospice aide and homemaker services
** Physical, occupational and speech-language pathology therapy services
** Short term inpatient and respite care
** Social worker services
** Grief and loss counseling for the member and his or her family
When a member/patient enrolled in hospice
receives care from your practice or
facility, it is very important that all of the care be
coordinated with their hospice physician. Once a Member is enrolled in hospice,
CarePlus Health Plans, Inc. (CarePlus) is not financially responsible for any
services covered by Medicare regardless of whether the care is related to the
hospice diagnosis or not, as long as the service provided is a Medicare covered
benefit. CarePlus enrolls Hospice members into a new group effective the 1st of
the month, following election of hospice, and removes them from the group at
the end of the month, if the Member terminates or revokes the hospice
benefit. The Plan will continue to assist in coordination of the member’s
care to the best of its ability, however, the payment process to providers
changes.
For Hospice diagnosis related care, providers need to bill the
Medicare-approved hospice organization with which the patient is
enrolled. For care not related to the hospice related diagnosis, that is
a Medicare covered benefit, providers need to bill the Fiscal Intermediary for
CMS directly. If a Member’s hospice is revoked during a month, you must
continue to bill the hospice organization or the Fiscal Intermediary for CMS
through the end of that month. CarePlus is only responsible for
additional benefits not covered by Medicare, i.e. the transportation benefit.
Any claims received by CarePlus for Medicare-covered services that are not
additional plan benefits, will be denied by the Plan.
Note: A member who has elected hospice and requires medical treatment for a
non-hospice condition can do one of the following:
(1) Use plan providers and services. In such a case, the member only pays plan
allowed cost-sharing, and the provider would directly bill FFS for (Parts A and
B services); or
(2) Use non-network providers and be
treated under FFS. In such a case,
if the service is not emergent/urgent care, the member
would pay the total FFS allowed cost-sharing.
When hospice services are requested by a Member, confirmed with the Centers for
Medicare & Medicaid Services (CMS) and updated in the Plan’s system,
the Member is sent a new enrollment card reflecting a new group number
beginning with RH*. This process may take time, depending on when the Hospice
Form is received by CMS and when their system is updated.
It is important that your staff and/or billing company understands the process
required to bill the Fiscal Intermediary for CMS for members of our Plan
that are enrolled in hospice. Please communicate this information to your staff
and/or billing company as appropriate.
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