Capabilities

Woman in wheelchair with two caregivers. Hosparus offers hospice services to patients with a six-month prognosis, regardless of ability to pay. Image courtesy of Morris Images, New Albany.

Taking care. Hosparus offers hospice services to patients with a six-month prognosis, regardless of ability to pay.

On this page:

After-hours care.
Coverage of medications related to diagnosis.
Coverage and elivery of durable medical equipment.
Admission with six-month prognosis.
Hosparus and the Medicare benefit.

Hosparus is a nationally acnowledged leader in hospice and palliative care. Our capabilities are listed here.

After-hours care

Hosparus team members provide care to patients and families during regular business hours (Monday to Friday, 8:30 a.m. to 5 p.m.). After hours, patients and families can call the Hosparus office for assistance. When an emergency situation cannot be resolved on the telephone, a hospice professional will visit the patient.

Coverage of medications related to diagnosis

Hosparus covers the cost of medications related to the hospice diagnosis. In conjunction with the Hospice Pharmacia, a pharmacy specializing in medications needed by hospice patients, we have a list of medications proven effective for relieving the symptoms experienced by people with life-limiting illnesses. Those medications are covered. However, sometimes patients take other medications that are not covered by the hospice benefit. The Hosparus team will work with the patient's doctor to get related medications changed to medications that are included in the hospice guidelines.

Coverage and delivery of durable medical equipment

The hospice benefit offered by Medicare provides for delivery of equipment to a patient's home.

Admission with six-month prognosis

A patient with a terminal illness with a six-month prognosis is eligible for hospice care, regardless of ability to pay.

Hosparus and the Medicare benefit

Provided by the National Hospice and Palliative Care Organization, below is a description of the hospice Medicare benefit:

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services for their life-limiting illnesses. Hospice care also supports the patient's family and loved ones through a variety of services, enhancing the value of the Medicare Hospice Benefit.

The Medicare Hospice Benefit provides for:

Physician services.
Nursing care.
Medical appliances and supplies.
Drugs for symptom management and pain relief.
Short-term inpatient care.
Homemaker and home health aide services.
Counseling.
Social work service.
Spiritual care.
Volunteer participation.
Bereavement services.

Who is eligible?

Medicare has three key eligibility criteria:

The patient's doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course.
The patient chooses to receive hospice care rather than curative treatments.
The patient enrolls in a Medicare-approved hospice program.

Hospice can be involved when the patient is using his or her Medicare skilled benefit if the skilled benefit is for something unrelated to the Hospice terminal diagnosis. The facility providing the skilled benefit cannot use the patient's hospice terminal diagnosis as one of their primary reasons for billing. If the skilled patient receives hospice care under these conditions, the facility must obtain a denial from hospice prior to billing Medicare for the skilled benefit unrelated to the hospice terminal diagnosis. For billing purposes, skilled facilities must place the 07 modifier in box 18 of the UB-04 (CMS1450).

Payment for hospice

Medicare pays the hospice program a per diem rate intended to cover virtually all expenses related to addressing the patient's terminal illness.

Because patients require differing intensities of care during the course of their disease, the Medicare Hospice Benefit affords patients four levels of care to meet their needs:

Routine home care.
Continuous home care.
Inpatiend respite care.
General inpatient care.

The Medicare Hospice Benefit rates increase annually based on the Hospital Market Basket Index. With the advent of costly new drugs and treatments such as palliative radiation, the average cost to hospices has risen much faster than the hospice benefit reimbursement rates.

Medicare-certified hospice programs must offer all services required to palliate the terminal illness, even if the patient is not covered by Medicare and does not have the ability to pay.

For more information about the hospice Medicare benefit, call (800) MEDI-CARE (1-800-633-4227). TTY users should call (877) 486-2048 or visit www.medicare.gov.