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Hospice Eligibility Quick Reference Guide (This serves as a guideline for hospice eligibility; it does not take the place of a physician or their professional recommendations.) www.hospice.org 618.235.1703 • 618.997.3030 1-800-233-1708
Overall the process of enrolling patients into hospice and determining hospice-appropriate diagnoses requires critical thinking by the physician, with maintaining a current list of conditions and removing inappropriate history codes when applicable.
Medicare makes daily payments based on 1 of 4 levels of hospice care: Routine home care: A day the patient elects to get hospice care at home and isn’t getting continuous home care. A patient’s home might be a home, a skilled nursing facility (SNF), or an assisted living facility.
Common conditions that qualify for hospice care include heart failure, cancer, lung disease, dementia, ALS, end-stage renal disease, HIV/AIDS, liver disease, and multiple sclerosis. Hospice care focuses on symptom management and supporting patients and their families during the end-of-life journey.
Quick Reference Guide. Hospice care eligibility must evidence a prognosis of six months or less, with a certification by both the patient’s attending physician and the hospice physician. This guide is designed to assist you in determining the earliest time your patient may be eligible for hospice.
This list includes proposed and final regulations and notices about Medicare Hospice Payment.
Your plan must help you locate a Medicare-approved hospice provider in your area. Original Medicare will cover everything you need related to your terminal illness once your hospice benefit starts, even if you stay in your plan.