Ask the payment expert: how much will hospice cover?

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Ask the payment expert
Ask the payment expert
Recently, we had a hospice tell us we have to cover the resident under Medicare for a fractured hip. Doesn't hospice cover everything?

There is a way that a facility can cover a hospice resident under Medicare A for a condition not related to the terminal illness. However, be very careful. In order for a skilled nursing facility to cover a hospice resident, the covered service must be totally unrelated to the terminal illness.

At first look, you may think a fractured hip from a fall is unrelated. However, you need to determine if the fall is unrelated or if the fall is a result of a pathological fracture caused by the terminal illness. I would have the attending physician, hospice medical director and the hospice nurse do good documentation to show why the fracture is unrelated to the terminal disease.

Also, be aware that in December 2008, new conditions of participation went into effect for hospices. It requires that the hospice be responsible for “professional management” of the hospice services the resident is receiving, including furnishing the care and services related to the terminal illness and related conditions. The plan of care in the skilled nursing facility must be coordinated with hospice, and a designated hospice nurse must be identified to coordinate the resident's plan of care.

There are also guidelines for what needs to be included in hospice contracts. In addition, the advance copy of F-309, which became effective March 1, 2009, now provides some additional guidance for the nursing facility's responsibility in working with the hospice to provide pain management and other services according to the plan of care.

Hospice staff should coordinate that care, and they need to be a part of your care planning process.