Medicare has recently modified eligibility criteria for hospice services effective immediately.
Key changes include:
Medicare no longer accepts claims using the primary diagnosis of debility and decline/failure to thrive, or associated diagnoses (codes 780-799). Supporting documentation must now be submitted with the claim supporting the terminal diagnosis. The question that must be answered is: What is going to take the patient’s life? This determines the terminal diagnosis. Providence Hospice has created a pocket guide with the new Medicare guidelines and a score sheet to help you determine hospice eligibility. When referring, please use this guide to determine diagnosis or reasons for debility. Include all supporting co-morbid conditions contributing to the patient’s disease trajectory.
Providence Hospice staff is available to assist with any questions you may have regarding hospice referrals or to deliver hard copies of any of the attached tools. For assistance please call our office at 541-732-6500. On-call staff is available after hours and on weekends, as needed. We appreciate your partnership as we navigate these changes. We look forward to serving you, your patients and their families.
Download the Hospice pocket guide
Download the Hospice guidelines tip sheet