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Hospice vs. Palliative Care

What Is Hospice Care?

Hospice care can be defined as specialized medical services provided to support you or a loved one during the advanced or last stages of illnesses such as heart failure or cancer. It also involves providing emotional and spiritual support as the focus is on ensuring comfort and improving the quality of life to the extent possible, rather than curing you or your loved one of the illness. Additionally, hospice care helps your family members to manage the practical as well as emotional challenges associated with providing care for you or a loved one. Ultimately, it is all about helping you to lead an alert and pain-free life, affirming the fact that life and death are a natural process.

Why Should You Choose One?

The goal of any hospice care provider is to keep you not only comfortable, but also to help you to live each day to the fullest extent possible with your family members and friends. The philosophy followed by a hospice is different from that of a hospital where the focus is on providing treatment. In hospitals, health professionals work hard to treat your disease. The intention of the hospice care is neither to speed up nor prolong the process of dying. Instead, care givers try their level best to provide relief from pain and a number of other symptoms.

When you are in the last stages of your life, you may feel totally out of control and wonder as to what would happen to you. Hospice care helps to show to you your options which in turn would help you to get back some control and make decisions about certain things that you feel are important to you.

If you think a loved one would benefit from hospice care, you can reach us on 404-572-9966. Our representative will visit you to review your needs and that of the patient and work with the physician for enrollment into our program.

 

How to Pay for Hospice:

For Patients with Medicare

For Medicare beneficiaries, hospice care is covered under Medicare Part A. You are eligible for Medicare hospice benefits when:

  • You are eligible for Medicare Part A
  • Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live.
  • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness, and
  • You receive care from a Medicare approved hospice program

For Patients with Medicaid

The State Medicaid program determines your eligibility. Medicaid eligibility is limited to individuals who fall in certain categories. Medicaid is a state administered program and each state sets its own guidelines regarding eligibility.

The hospice service benefit is an optional benefit, which States may choose to make available under the Medicaid program. The purpose of the hospice benefit is to provide for the palliation or management of the terminal illness and related conditions. Under Federal guidelines, the hospice benefit is available to individuals who have been certified by a physician to be terminally ill (if he/she has a medical prognosis that his or her life expectancy is 6 months or less.) A hospice must meet the Medicare conditions of participations applicable to hospices in order to receive payment under Medicaid.

Hospice will provide all services for care of the patient’s life-limiting illness directly or through contracted services.

During the patient’s hospice benefit period, Hospice, through Medicare or eligible Medicaid programs, will cover the patient’s full financial responsibility for these services, except under any of the following circumstances:

  • If the patient decides to pursue a curative, non-palliative course of treatment;
  • If the patient enters an inpatient facility without prior authorization from Hospice;
  • If the patient enters an inpatient facility for a condition unrelated to his/her primary hospice diagnosis;
  • If the patient enters an inpatient facility that does not have a contract with Hospice, to provide care to Hospice patients;
  • If you receive the same type of care from a different provider, unless you change your provider.

In each of the above cases, the patient will need to revoke his/her hospice election and return to traditional Medicare or Medicaid coverage, and consequently forfeiting the remaining days within that benefit period.

Participation in the Medicare or Medicaid Hospice Benefit is subject to certain restrictions. Medicare and Medicaid reimburse the hospice and the patient’s private physician for the care related to the hospice diagnosis. Care not related to the hospice diagnosis is reimbursed according to the traditional Medicare or Medicaid reimbursement system. Medicare and Medicaid Hospice Benefit will not pay for unauthorized services under the plan of care.

The Medicare and Medicaid Hospice Benefit provide for four levels of care: Routine Home Care, Inpatient Care, Respite Care and Continuous Care. Any change in a patient’s level of care must be approved in the plan of care.

The Medicare Hospice Benefit is divided into benefit periods. The first two benefit periods are for 90 days. There is an unlimited number of additional 60-day benefit periods provided the physician and hospice team determine the patient continues to be eligible for hospice services.

For Patients with Medicare and Medicaid

Medicaid reimbursement, related to hospice services, can cover certain services that Medicare does not cover. If a Medicaid hospice patient resides in a Nursing Facility, the State must pay the hospice for the room and board services provided by the Nursing Facility.

For Patients with Other Insurance Coverage

Various types of insurance plans cover many of the professional services offered by Hospice. A Hospice Social Worker is available; to discuss insurance to enable the patient to receive the maximum available coverage for needed services. By speaking to the insurance company directly, Hospice can better help the patient know exactly what is covered and what, if anything, will remain the financial responsibility of the patient.

You will be informed before care is initiated, orally and in writing, of the extent to which charges the patient may have to pay. After the insurance company makes its payments, if there is an uncovered balance payable to Hospice, our staff will discuss this with the patient or family, and charges will be billed directly. If a statement of services sent to any third party payer is not paid in full within 90 days of it being mailed, or if there is no third-party payer that will reimburse Hospice for services rendered, the patient will be expected to pay in full the outstanding balance. Hospice will never discontinue services because of a proven inability to pay.

Private Pay

If insurance coverage is unavailable or insufficient, the patient and the patient’s family can discuss private pay and payment plans.