According to a recent Gallup poll, nine out of 10 adults would prefer to die in their own homes, free of pain, surrounded by family and loved ones. If your patients meet hospice criteria and fall into this category, at-home hospice care might be the right option.
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Making a Referral: Hospice Criteria
To refer a patient to hospice, a physician must submit an order of admittance to St. Joseph Hospice along with the patient’s medical history and latest physical records so we can verify eligibility. To begin the hospice admission process, the physician must also submit a signed certification of terminal illness stating a probable prognosis of six months or less, assuming the disease follows its natural course.
Transition from Home Health to Hospice Care
If your home health patient meets hospice eligibility and you’re looking to transition the patient to hospice, you’ll need to order the home health agency to contact St. Joseph Hospice for a palliative-care consultation. Our Board-Certified hospice and palliative care physicians are available 24/7, with nurses available to handle crises around the clock. If the patient opts for hospice, we will work with the individual to ensure a smooth transition.
We must re-evaluate hospice eligibility for each patient every 60 to 90 days to determine if he or she continues to meet hospice criteria for care. A face-to-face evaluation is required for all patients entering their third (or subsequent) certification period. St. Joseph Hospice will provide staff for these evaluations.
Under Medicare Part A, hospice is paid at 100% of the allowable fee schedule, and St. Joseph Hospice will pay physicians per contractual agreements. St. Joseph Hospice is also required to obtain a physical billing number from Medicare.
Attending physicians not employed by hospice for hospice-related care will need to bill with Medicare Part B, using CPT and ICD codes. They’ll also need to use HCPC modifier code GV and GW to indicate that they’re not employed by hospice and not related to terminal DX. For care not related to the hospice diagnosis, use the 07 code. These codes also allow outside physicians to be reimbursed for seeing a patient while the patient is in hospice. Under Medicare Part B, hospice is paid at 80% of the allowable fee schedule. Call your local SJH Executive Director with any additional questions. They should be able to research your question and provide an accurate answer.
Clinical Findings for Physicians
“Hospice Matters for Physicians” is a complimentary publication provided by St. Joseph Hospice that offers the latest clinical findings and news related to serious illness and palliative care. Ask your St. Joseph Hospice Patient Care Representative for a current full-color print edition or download here.