Part B Insider (Multispecialty) Coding Alert

Published on Mon Oct 04, 2010 PDF

Medicare may not pay for discharge planning when a hospice patient is no longer terminally ill -- but you'll have to.

"Once it is determined that the patient is no longer terminally ill, the patient is no longer eligible to receive the Medicare hospice benefit," CMS says in a response to a question about whether a hospice can keep a patient on the hospice benefit while completing discharge planning. "In such instances, the hospice must discharge the patient from the Medicare hospice benefit."

But hospices are still left holding the bag for the discharge planning. "Our regulations ... require that the hospice have in place a process 'that takes into account the prospect that a patient's condition might stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill,'" CMS says in Q&A #10823. "When a hospice has not properly planned for a discharge, we would expect the hospice to continue to care for the patient at its own expense until required discharge planning is complete."

The Q&A is at https://questions.cms.hhs.gov/app/answers/detail/a_id/10823/kw/hospice.