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Benefits and Reimbursements
Hospice Coverage and Benefits
Hospice services are covered by Medicare and Medicaid, managed care and private insurance companies.
Coverage includes all levels of care and medications, durable medical equipment, dressings, supplies and transportation related to the disease process. 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.
Physician Reimbursement
Your financial relationship with a patient is not affected by their Hospice election.
As an attending physician of a Medicare Hospice patient, you are eligible for additional reimbursement from Medicare for the documented time you spend on 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 care requirement of 30 minutes per patient.
The billing code for Care Plan Oversight is: G0182. New Jersey Hospice's Provider Number, which must appear in Box 23 on the form, is: 491537.
Medicare and Medicaid and Private Insurance Benefits
Both Medicare and Medicaid provide major medical coverage for Hospice care of your terminally ill patients without deductions or co-payments, and some states require all private insurers to provide a 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 symptom 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 and Medicaid 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 Reimbursement
Inpatient services are reimbursed by Medicare and Medicaid 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.
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