Hospice Patients Alliance – Medicare, Medicaid and Private Insurance for Hospice #ardilaun #hotel

#private hospice



The major sources of payment for hospice care are Medicare, Medicaid and private insurance, although Medicare certainly provides for the larger segment of the hospice population. Which source of payment covers for your hospice services should have little effect on the type and quality of services you receive.

Any hospice which receives reimbursement from Medicare or Medicaid must be licensed and certified by the State agency which surveys and inspects health care agencies. If the hospice is part of a national or regional corporation, the location where the hospice actually provides services determines which State performs these inspections. Most private insurers require the hospices to meet the same requirements as do Medicare and Medicaid, and to provide the same set of services included in the standard “Hospice Benefit.”

There is an additional benefit to having a private insurance company cover your hospice services: you have an insurance company “case manager” who reviews the services needed by the patient and family, and the services being provided by the hospice. Unfortunately, in some instances, some hospices do not provide all the services you are entitled to! In these cases, you need to be assertive and speak with the RN case manager, the hospice’s director or the hospice Medical Director.

If you still experience any difficulty getting the hospice to provide adequate services, do not hesitate to call your insurance company’s “case manager.” They can “go to bat” for you to get you the services you need. If the hospice still refuses toprovide the services you need, consider switching hospices. Hospices will usually “back down” and provide what you need if you let them know that you will switch. Do not be fooled by “threats” that hospice services will be interrupted or that “it’s not possible” to switch at this time.” Nonsense. You always have the right to choose whichever physician you wish and change at any time; you always have the right to switch hospices to get the services you are entitled to! If you do switch physicians or hospices, the hospice must assure a smooth transition and continuity of services throughout the change.

Because the Federal and State governments wish to “get their money’s worth” for the funds they pay out to the hospices, it is important to report any hospices who do not provide the full set of services needed to meet the patient’s needs. Since Medicare and Medicaid pay a hospice on a “per-diem” or daily basis for all the services needed, the hospice is receiving payment on the assumption that it will actually provide those services. When a hospice does not provide services needed and which you are entitled to, that hospice may be involved in “health care fraud.” You can help stop the rampant exploitation of the Medicare and Medicaid systems by unscrupulous administrators. report these violations to the Office of the Inspector General. (See “Links to Report Fraud in Hospice” at Section 10 of this text) .

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Private Home Care Provider #bristol #hotels

#private duty home care


Private Home Care Provider

A Private Home Care provider provides “private home care services” which means an agency that is licensed to provide through its own employees or agents services at a client’s residence that involves direct care to that client and includes nursing services, personal care tasks and companion or sitter tasks:

Nursing services, provided that such services can only be provided by a person licensed as a Registered Professional Nurse or Licensed Practical Nurse in accordance with applicable professional licensing statutes and associated rules.

Personal care tasks means assistance with bathing, toileting, grooming, shaving, dental care, dressing, and eating; and may include but is not limited to proper nutrition, home management, housekeeping tasks, ambulation and transfer, and medically related activities, including the taking of vital signs only in conjunction with the above tasks.

Companion or sitter tasks means the following tasks which are provided to elderly, handicapped, or convalescing individuals: transport and escort services; meal preparation and serving; and household tasks essential to cleanliness and safety.

Am I in the right place?
  1. Do you intend to provide services to clients living in their own homes? If Yes. continue; If No Click here.
  2. Do you intend to have employees? If Yes. continue; If No Click here .
  3. Do you intend to provide physical, speech, or occupational therapy; medical nutrition therapy; medical social services; or home health aide services? If Yes. Click here ; If No Continue.
Next Steps

Continue this process by reading the Rules Regulations ;
Rules and Regulations for Private Home Care Provider . Chapter 290-5-54, et seq. Revised February 13, 2008
Enforcement of Licensing Requirements . Chapter 290-1-6, et seq. Effective August 16, 1993

Complete the Application Packet – In order to process your application, ALL of the documents included in the application packet must be submitted; and

Sign and return the Application Checklist with the entire Application Packet.

Medicare, Medi-Cal, and Private Insurance – Skirball Hospice #pallative #care

#medicare hospice coverage


Medicare, Medi-Cal, and Private Insurance

Hospice care is a fully covered benefit under Medicare Part A and the Medi-Cal program in California. Most insurance companies also provide coverage for hospice care subject to individual policy deductibles, coinsurance, and out-of-pocket limitations.

When a patient is considering hospice care, the insurance coverage of the patient will be reviewed and discussed with family members to be sure they understand the financial benefits provided to the patient by their current insurance carrier. If there are any questions, they will be resolved prior to the start of care.

For an individual eligible and enrolled in Medicare or Medi-Cal, there is no out-of-pocket cost to select the hospice benefit. The hospice benefit includes full payment for all staff services, supplies, medical equipment, and medications, provided they are directly related to the hospice primary diagnosis.

To qualify for hospice care, two physicians, generally the patient’s attending physician and the hospice physician, evaluate the patient to determine if the individual has a life-limiting illness with a life expectancy of six months or less if the disease process follows a normal course.

Because it is impossible to know the progression of a disease with accuracy, patients may receive the hospice benefit for longer than six months provided they continue to meet the Medicare or insurance company eligibility criteria. After six months, patients are periodically assessed by hospice physicians for continued coverage.

When an individual elects the hospice benefit for a specific disease diagnosis, they are opting out of traditional Medicare coverage and opting into the special Medicare hospice benefit. By doing this, they agree to pursue comfort and palliative measures only and not seek aggressive or curative therapy for that disease. Should other diseases develop, unrelated to the hospice diagnosis, those may be treated and covered under the traditional Medicare program.

When all requirements are met, the following services will be covered by your health plan:

  • Physician services
  • Nursing care
  • Home health aide
  • Medical social services
  • Bereavement counseling
  • Spiritual counseling
  • Dietary counseling
  • Volunteer services
  • Physical therapy, occupational therapy, speech therapy
  • Medical equipment, services, and supplies
  • Medications for pain and comfort related to the terminal illness and approved by Skirball Hospice
  • Short-term inpatient care for pain and symptom control
  • Diagnostic studies
  • Short-term continuous care for focused symptom relief
  • Respite for up to 5 days to provide relief for caregivers

The following services are not covered:

  • Treatment for the terminal illness which is not for palliative symptom management and is not within the hospice plan of care
  • Care provided by another hospice or home health agency
  • Private caregivers/sitter services
  • Dietary supplements unless directly related to terminal illness
  • Services not authorized by Skirball Hospice
  • Ambulance transportation not included in the plan of care
  • Supplies not related to terminal illness
  • Chemotherapy drugs or other drugs deemed aggressive in nature
  • Medications not related to the terminal illness
  • Visit to the emergency department or inpatient hospitalization without prior authorization from Skirball Hospice
  • Diagnostic studies or any treatments not authorized by Skirball Hospice

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Private duty nursing #gta #hotels

#private duty nursing