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The Medicare Hospice Benefit |
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Initial and ongoing requirements for a beneficiary to be eligible to receive hospice services under the Medicare Hospice Benefit include:
Eligibility: A patient must be eligible for Medicare Part A
Informed Consent: The beneficiary must agree that he or she wishes to receive “palliative, not curative, care” and to surrender all other Medicare benefits relating to the terminal diagnosis, with the exception of the professional services of his or her attending physician.
Initial Prognosis: The attending physician and the hospice medical director or team physician must certify that the patient has a “medical prognosis that his or her life expectancy is six months or less, if the illness runs its normal course.”
Ongiong Prognosis: At successive intervals of 90-, 90- and unlimited 60-day periods, a hospice physician must certify that the patient’s prognosis continues to be six months or less from the date of the most recent certification.
While individual patients may receive hospice services for periods beyond six months, Medicare has a “global cap” on the total annual monies that a hospice can receive. This global cap forces hospices to work closely with community physicians to assure patients’ appropriateness, but does not “punish” a beneficiary or his or her physician if a patient is fortunate enough to live beyond six months.
Respectfully Submitted by Vitas Innovative Hospice Care
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