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Weekly Tips & Insights

Six Commonly Asked Questions About Hospice Billing and Medicare

Many caregivers have questions regarding what is covered by Medicare when it comes to hospice, and many are surprised to find out that hospice is 100% paid for. Learn more about qualifications for hospice care and what is and isn’t covered.

What requirements must one meet for Medicare to cover hospice?

To qualify for hospice care, a hospice doctor or your primary care physician must certify that you’re terminally ill, meaning you have a life expectancy of six months or less. When you agree to hospice care, you’re agreeing to comfort care instead of care to cure your illness.

Are there any premiums associated?

Medicare beneficiaries do not have a copay for hospice. Hospice will bill Medicare and be reimbursed by them.

What does coverage include?

The Medicare Hospice Benefit pays for most of the health services related to the terminal illness the patient has. A co-payment may apply for medications and respite care.

Services that are covered include:

  • Team-directed care with the attending physician and medical director involved in care decisions.

  • Specialized nursing care

  • Spiritual counseling

  • Social services

  • Volunteer support

  • Home Health Aide/Homemaker services

  • Physical therapy, occupational therapy, speech therapy

  • Medication controlling symptoms related to the terminal illness

  • Equipment and medical supplies related to the terminal illness

  • Short term in-patient care to provide respite for caregiver

  • Short term in-patient care for pain control or acute symptom management

  • Counseling

What doesn’t Medicare cover?

Most purchase items are not included. Examples of these include sheets, pillows, pajamas, special cushions or anything not related to the terminal illness.

How long can you get hospice care and have it be covered?

As long as the patient is showing a progression of the disease and the hospice interdisciplinary team believes the patient is still six months from death, the patient will remain eligible. Should the patient stabilize or get better, they will graduate from hospice and may be admitted at another time.

Beyond hospice care services, what costs might be associated with care?

Hospice doesn’t stay day and night with the patient, so private duty services can be hired to provide that extra care. Hospice care also does not pay for nursing home room and board.

For more information about our hospice care services, visit our website.

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