Hospice Eligibility – Admission Criteria
To be eligible for North Delta Hospice and Palliative Services, a patient must agree to palliative and comfort care rather than curative attention. Both the attending physician and the assigned North Delta physician must also affirm that the patient has an estimated life expectancy of six months or less, if the illness runs its normal course. North Delta will conduct the patient evaluations to determine if the hospice services are suitable for the patients.
Home Health Eligibility – Admission Criteria
Any patient who is under the care of a physician, is essentially homebound and/or in need of homecare services are eligible for Home Health.
Hospice Coverage and Benefits
Hospice services are covered by Medicare, managed care and private insurance companies.
Does Medicaid cover Hospice services?
Coverage includes all levels of care and medications, durable medical equipment, dressings, supplies and transportation to essential and related services. All patients that meet Hospice criteria will be admitted regardless of ability to pay and no patient will be discharged due to lapse of insurance or inability to pay for care.
Your financial relationship with a patient is not affected by their Hospice selection. As an attending physician of a Medicare Hospice patient, you are eligible for additional reimbursement from Medicare for the documented time you spend on the required Care Plan Oversight.
You can be reimbursed regardless of whether you are a Medicare participating physician or not. Reimbursement is made monthly on a per patient basis with a minimum patient care requirement of 30 minutes.
Medicare and Private Insurance Benefits
Medicare provides major medical coverage for the Hospice care of your terminal patients without deductions or co-payments, and some states require all private insurers to provide a Hospice benefit. Your patients and their families will usually have no out-of-pocket expenses once they elect to use their Hospice benefit.
The benefit has four levels of care, allowing Hospice to serve as the case manager for your patients in any setting:
Routine Home Care is the basic level of care needed to maintain your patient in their residence.
Continuous Care is a level of care that allows Hospice to provide round-the-clock bedside nursing services for symptomatic management over short periods of time.
Inpatient Care is a level of care that enables Hospice to transfer your patient to a Hospice inpatient unit or contracted facility, such as a hospital or skilled nursing unit.
Respite Care is a level of care that allows Hospice to give family caregivers a 5-day respite by transferring your patient to a contracted facility.
The Medicare Hospice Benefits fully cover all Hospice services in the four levels of care, including all medications, durable medical equipment and medical supplies related to the terminal condition. Your patients and their families will usually have no out-of-pocket expenses once they elect to use their Hospice benefit.
Inpatient services are reimbursed by Medicare as well as by many private insurers and HMOs once specific clinical criteria are met. Patients are responsible for all charges for which Hospice is not reimbursed.
Long-term Care Reimbursement
You may refer patients who reside in a long-term care facility to Hospice and they will receive the same benefits as Hospice patients do in a private home. You may make an unlimited number of visits to your long-term care Hospice patients and Medicare will reimburse you for all documented, medically necessary visits billed directly to Medicare under Part B.
How to Work With Hospice: Admission Options
Hospice patients may be admitted at any one of four levels of care encompassing Routine Home Care, Continuous Care, Inpatient Care or Respite Care.
General Inpatient Care is short-term, acute care which can be be provided at inpatient facilities located in hospitals or skilled nursing facilities.
Routine Home Care involves intermittent visits as needed at the patient’s residence, which may be a private home, group home or skilled nursing facility.
Continuous Home Care provides increased nursing care to manage symptoms up to 24 hours per day for a short period of time.
Inpatient Respite allows for a 5-day respite for caregivers by transferring the patient to an inpatient unit or other contracted facility