Hospice vs Medicare?

[Maga63]

Resident with Dx ALS and on a vent with a new MC stay, decided to go on hospice and signed up on hospice on 4/23/12 day 14 of his stay. These are the questions we have:

1) could he have stayed on Medicare for his vent/Tf/trach etc and be on hospice for his terminal stage ALS?

2) would hospice and SNF both bill Medicare?

3) What do we need to do?

Thanks

[Talino]

the condition for which a skilled service is provided must be unrelated to the condition for which the resident receives hospice care.

example: while receiving hospice care for cancer, the resident falls and breaks a hip. he now requires skilled therapy. hospice services for the cancer are billed with the following types of bill: 81x or 82x. the therapy services are represented by condition code 07 (your billers would understand these jargons). the therapy services will be included in the snf pps and consolidated billing. hence you will complete the required mds/pps assm'ts.

the need for a vent/trach (inability to breathe) and tf (inability to swallow) is a clear indicator of an end stage als.

[Maga63]

Talino, thanks! One more question....I missed an important piece... finances! By coming off Medicare to sign on hospice, which he really wanted to do to provide emotional support for the family, this resident now became private pay, which in our vent facility is steep.... we did took him off Medicare but the new question is could he have stayed on Medicare and sign up on hospice and pay hospice privately? It would save them a LOT of $$ if possible....

Thanks

[Talino]

The election of hospice can be revoked at any time. The resident can then access Medicare SNF benefits.

see page 7 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//bp102c09.pdf 20.2 - Election, Revocation...Hospice