Reimbursement of Services
Hospice care is an elected benefit that is covered under Medicare Part A for a patient who meets all of these
requirements:
- The individual is eligible for Part A
- The individual is certified as terminally ill, meaning a medical prognosis of life expectancy that is six months or less if the illness runs its normal course. There must be clinical information and other documentation that support the medical prognosis
- The individual receives care from a Medicare-approved hospice program
- The individual signs a statement indicating that he or she elects the hospice benefit and waives all other rights to Medicare payment for services related to the treatment of the terminal prognosis. Medicare will continue to pay for covered benefits for services unrelated to the terminal prognosis
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Coverage of hospice services
The Medicare hospice benefit includes these hospice services for the palliation and management of the
terminal prognosis:
- Physician services furnished by hospice-employed physicians, nurse practitioners (NPs) and physician assistants (PAs) or by other physicians under arrangement with you
- Nursing care
- Medical equipment
- Medical supplies
- Drugs for pain and symptom management
- Hospice aide and homemaker services
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Dietary counseling
- Spiritual counseling
- Grief and loss counseling for the individual and his or her family before and after death
- Short-term inpatient care for pain control and symptom management and for respite care and any other hospice services, as specified in the patient’s plan of care (POC) and furnished or arranged by you, as reasonable and necessary, and for which payment may otherwise be made under Medicare
Medicare will not pay for the following services when hospice care is chosen
- Hospice care furnished by a hospice other than the hospice designated by the individual, unless furnished under an arrangement by the designated hospice
- Any Medicare services related to the treatment of the terminal prognosis for which hospice care was elected or are equivalent to hospice care, with the exception of care furnished by the designated hospice, care furnished by another hospice under arrangements made by the designated hospice, or care furnished by the individual’s attending physician who is not an employee of the designated hospice or receiving compensation from the hospice under an arrangement for those services
- Room and board, unless it is for short-term inpatient care that you arrange
- Covered care in an emergency room, hospital, or other inpatient facility, outpatient services, or ambulance transportation, unless these services are either arranged by you or are unrelated to the terminal prognosis