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CAPC Palliative Care Discussion Forum
Billing and Finance
Medicare Advantage and HospiceAuthor: yaegerj
Date: Oct 27, 2010 2:46 pm
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The CMS publication Medicare Hospice Benefit includes a section entitled: Hospice Care if You are in a Medicare Advantage Plan (page 8) - see http://www.gov/publications/pubs/pdf/02154.pdf
The important thing to note is that hospice is carved out of the Medicare Advantage Plan coverage - so all hospice services are covered under 'Original Medicare' and must be billed separately by a Medicare-certified Hospice as would be the case for a hospice patient not enrolled in a Medicare Advantage Program (MAP).
If the patient's MAP covers extra services not covered by Original Medicare (e.g. dental and vision benefits), the coverage for these services will continue while the patient is on hospice if the patient opts to continue in the Medicare Advantage Plan while receiving hospice services. In this case, the patient must continue to pay the plan's monthly premium.
Each Medicare Advantage Plan sets the charges its members must pay which may include co-payments, and/or co-insurance amounts. In addition, the beneficiary must continue paying the monthly Medicare Part B premium amount.
Bottom line: Medicare Advantage plans do not pay for hospice. Hospice providers submit claims to Medicare for covered hospice services.
One further consideration: the PPACA Health Care Reform bill contains provisions to decrease the incentives paid to MAP providers. As a result, a number of these plans are either limiting offerings or in some cases ceasing operations.
The program needed some basic information about hospice. They were upset with physicians (non-hospice) who don't understand that sending a patient to a nursing home for their "skilled benefit" with the plan to then admit to hospice doesn't make sense. I understand their frustration and agreed to write an article in their newsletter to their providers explaining this. They were also upset about a patient or two that I had advocated for continued hospice services while needing a short rehab stay for an unrelated problem. I explained the law to them as best i could but they didn't want to accept that this is permissable.
They are also having a hard time with patients who are discharged from hospice and then need to start getting some of their services paid for by the HMO again. Before I came here, there was not a culture of discharging patients when they stabilized so this is fairly new to them.
Thanks again for your help and for using the forums!