Hospice Reimbursement

Public understanding could boost referrals for service

Nurse touching senior woman's shoulder
If more people understood hospice reimbursement, more people would access services. Vstock/Getty Images

The arena of hospice reimbursement care is often misunderstood by the public and, in fact, many have the perception that it is not a covered service. Then caregivers shy away from seeking hospice services.

Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid or a private insurance company, hospice will work with the person and their family to ensure needed services can be provided.

Medicare Hospice Benefit

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services.

More than 90% of hospices in the United States are certified by Medicare. Eighty percent of people who use hospice care are over the age of 65 and are thus entitled to the services offered by the Medicare Hospice Benefit.

If someone stops their hospice care, they will receive the type of Medicare coverage that they had before electing hospice and if eligible can go back to hospice care at any time.

Who is Eligible for Medicare Hospice Benefits?

People who are eligible for Medicare hospice benefits meet all of the following conditions:

  • They are eligible for Medicare Part A.
  • Their doctor and the hospice medical director certify that they have a life-limiting illness and the person may be expected to have six months or less to live.
  • The recipient signs a statement choosing hospice care instead of routine Medicare covered benefits for their illness.
  • They receive care from a Medicare-approved hospice program.

    What Does Medicare Cover?

    Hospices are required to provide these set of services to each person they serve:

    • Doctor services
    • Nursing care
    • Medical equipment (like wheelchairs or walkers)
    • Medical supplies (like bandages and catheters)
    • Drugs for symptom control and pain relief
    • Short-term care in the hospital, including respite and inpatient for pain and symptom management
    • Home health aide and homemaker services
    • Physical and occupational therapy
    • Speech therapy
    • Social work services
    • Dietary counseling
    • Grief support

    The Medicare Hospice Benefit does not cover treatment intended to cure an illness.

    Medications not directly related to a hospice diagnosis are not covered under the Medicare Hospice Benefit.

    Under Medicare law, no person may be refused hospice care due to inability to pay. Each hospice must have a financial specialist on staff to answer questions about receiving financial assistance.

    Medicare is not the only source of reimbursement for hospice services. Commercial Insurance may include hospice coverage. Managed care insurance companies identify their "network" and patients have to select a hospice within that network to receive coverage. Elderly nursing home residents on Medical Assistance may continue to receive the room and board coverage from Medical Assistance while receiving hospice care.

    U.S. Veteran's Benefits includes provisions for hospice care. And Long-term Care Insurance may reimburse some services not covered by Medicare.

    Educate your community and your team on the vast amount of covered hospice services so that they will be more receptive to considering this type of care for a loved one.

    Source: National Hospice and Palliative Care Organization

    Continue Reading