Eli's Hospice Insider
WHAT DO YOU THINK?When Can a Patient Receive Both Part A SNF Care and Medicare Hospice?
PDF
Be careful with this tricky scenario.
Answer: A person in a nursing home can be in a Medicare Part A SNF stay and hospice if the person's Part A stay is unrelated to his terminal illness, says Beth Carpenter, president of Beth Carpenter and Associates in Lake Barrington, Ill. But the hospice, including its medical director, and the SNF should have "a clear and documented discussion" as to whether the SNF condition is related to the terminal illness or not, Carpenter says.
Don't make this mistake: Some providers think that as long as the reason for the Medicare Part A stay and hospice involve different diagnoses, they can provide both, says Cherry Meier, VP of public affairs for VITAS Innovative Hospice Care in Flat Rock, N.C. But the rules say the reason for the Part A stay can't be related to the patient's terminal illness, she emphasizes.
What would be totally unrelated?
Fall-related injuries are the most common example, says Meier. But even there, you have to be careful because someone might fall due to a pathological fracture from a metastatic lesion in the bone, she adds; or he might fall due to cancer-related weakness and frailty. Medical reviewers may also argue that the drugs used to palliate the cancer could weaken bones, says Carpenter. But if the person truly has an accident -- and the person's terminal illness wasn't a contributory factor -- that might qualify as an example, Meier notes.
Another example might be someone with a terminal cancer diagnosis who requires Part A SNF care after a myocardial infarction where the person had a history of MIs, she adds.
Eli's Hospice Insider
- LEGISLATION:
Hospices Win Millions in Stimulus Bill
IT funding could also be a perk. Hospices have won back $135 million in Medicare [...] - PAYMENT COMPLIANCE:
Shore Up Documentation to Support Hospice Eligibility
Take these steps to prevent claim denials, payment recoupment, or worse. The first rule of [...] - CONTRACTORS:
RHHI-to-MAC Switch Scheduled For May
Two MAC regions are on hold, however. Get ready for some payment shakeups as the [...] - MEDICATION MANAGEMENT:
Know the Goal for Psychoactive Meds to Avoid Survey and Quality-of-Care Problems
Find out why and how to target inappropriate use of sedation. When does a medication [...] - Compliance:
RHHI Gets Tough With Hospice Cancer Claims
Reviewers shoot down claims for certification, terminal prognosis problems. You could wind up owing Medicare [...] - COORDINATION OF CARE:
CMS to Nursing Home Surveyors: Report Unresolved Hospice Concerns to Hospice Surveyors
Revised survey guidance for nursing homes includes this directive and more. The Centers for Medicare [...] - COMPLIANCE:
Revised F309 Guidance Spells Out What Nursing Homes and Hospices Should Do for Hospice Residents
Nursing home surveyors now have a specific tag for noncompliance. Hospices aren't the only ones [...] - WHAT DO YOU THINK?When Can a Patient Receive Both Part A SNF Care and Medicare Hospice?
Be careful with this tricky scenario. Question: When can a person legitimately receive both Part [...] - TRENDS:
Hospice Eligibility Is in the Hot Seat
Don't let this compliance issue burn your hospice. There's no shortage of reasons for hospices [...] - INDUSTRY NOTES :
President Obama's Proposed Budget Holds Good News for Hospices
While President Obama's proposed budget for 2010 cuts Medicare funding for some healthcare sectors, so [...]