HCFA offers reassurance about hospice certification
Don’t fear long-living patients
The Health Care Financing Administration (HCFA) is putting out the word that physicians won’t automatically be in trouble if their elderly hospice patients outlive their doctor-certified eligibility for Medicare’s hospice benefits.
According to the law, a Medicare beneficiary becomes eligible for hospice benefits when the person chooses palliative or other care from a hospice, and when a physician and a hospice medical director certify that the patient has a medical prognosis of six or fewer months to live.
Some physicians have been audited for not properly diagnosing patients then inappropriately enrolling them in a hospice. "Nevertheless, that is very different from situations in which a terminally ill patient has had the good fortune to live longer than predicted by a well-intentioned physician," notes a HCFA official.
Under HCFA rules, hospice patients can continue to receive Medicare benefits after six months as long as a physician "properly and conscientiously" recertifies the end-of-life prognosis. About 10% of Medicare patients receive hospice benefits longer than six months, according to HCFA.
To minimize future confusion over this six-month requirement, HCFA plans to develop a voluntary program in which physicians and hospice directors can turn to Medicare contractors for advice on a patient’s hospice eligibility. This, in effect, would be akin to getting pre-authorization to enroll that senior in a hospice program.
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