| Eligibility
“Who is eligible for Medicare hospice benefits?”
Hospice care is covered under Medicare Part A. You are eligible for Medicare hospice benefits when you meet all of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance), and
- Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live, and
- You sign a statement choosing hospice care instead of routine Medicare-covered benefits for your terminal illness*, and
- You receive care from a Medicare-approved hospice program.
Please note: Your regular Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.
Medicines
"Are all of my medications covered?"
Your prescription medications associated with your HOSPICE DIAGNOSIS will be paid for by the Hospice Medicare/Medicaid/Champus Benefit. Your nurse will be able to answer any questions you may have about drug coverage.
"Where do I go for my medicines?"
In general, medications are delivered by Valley Pharmacy (part of Valley Health Systems) with whom we have a contract. On the rare occasion a local pharmacy may be used.
Supplies and Equipment
"Are supplies covered?"
Hospice stocks some supplies at our office which will be made available to you as needed. Your nurse will discuss other needs with you and what is covered by Hospice. Generally speaking, items requiring a doctor's order are routinely supplied by Hospice (i.e., catheters).
"Is durable medical equipment covered (wheelchairs, bedside commode, hospital bed, etc.)?"
Yes, when your physician and the Hospice team determine that the item is appropriate, it is added to the Plan of Care and it becomes a covered item. Please note that Hospice makes the arrangements for delivery of approved items from a contracted supplier.
Changes in Location of Care
"What if I need hospitalization?"
The Hospice Medicare/Medicaid/Champus Benefit covers a hospital stay for symptom management related to the Hospice illness. The Hospice team, in consultation with you and your physician, makes the decision about hospital admission. YOU MUST CALL HOSPICE FIRST (540) 536-5210 or (800) 238-5678 during office hours (8:30am - 4:30pm). After hours, weekends or holidays, please call the same numbers and ask for the on call nurse for admission authorization. Unauthorized admissions may result in uncovered medical expenses.
"Which hospital provides Hospice in-patient care?"
Blue Ridge Hospice has an in-patient contract with Winchester Medical Center, Warren Memorial Hospital and Shenandoah Memorial Hospital. You will need to go to a hospital with whom Hospice has a contract and, where your physician has admitting privileges.
"What is respite care and where is it provided?"
Respite care is "relief" when the primary caregiver needs a break. It may be provided in the home for short periods by volunteers. It may be provided for up to five days at Winchester Medical Center, Warren Memorial Hospital or Shenandoah Memorial Hospital. Upon request by the family, with Hospice team approval, and when space is available.
"What is continuous care and when would it be appropriate?"
Continuous care is private duty care provided up to 24 hours per day for 1-2 days. It may be used to assist the patient through a "period of crisis" (example: start an IV for pain management at home). The Hospice team will make a recommendation for continuous care when indicated.
Other Services
"Who is included on the Hospice team which provides care for me and my family?"
Each patient and family has unique needs. Therefore, different families have different caregivers from Hospice. All families routinely have a nurse and social worker. Other team members may be added such as a home health aide, pastoral counselor or volunteer, etc. as needed.
Billing
"Will I receive a bill for Hospice services provided under the Hospice Medicare/Medicaid/Champus Benefit?"
Hospice is billed directly by the pharmacy, hospital, equipment company, etc. We work directly with Medicare/Medicaid/Champus so you will not need to be concerned with any related paperwork or bills.
"How are my attending physician's bills handled?"
Your attending physician will continue to bill as he has.
"What if I have other questions about this special Hospice Medicare/Medicaid/Champus Benefit?"
Please discuss your concerns with your social worker or nurse or contact (link to contact.html) the Hospice office at (540) 536-5210. We are pleased to be able to offer this special benefit and want to make it simple for you.
Questions and Answers on Hospitallization
In choosing the Hospice Medicare/Medicaid/Champus Benefit, you have elected to care for the patient at home. Hospital services may be part of the plan of care if the Hospice team determines this is the most appropriate care. The following information will answer some frequently asked questions about hospital services.
"How will I know if the patient needs to go to the hospital?"
For any problem or change in condition, call the Hospice number first (540) 536-5210 or (800) 238-5678 between 8:30am - 4:30pm. After hours, weekends or holidays, call the same numbers and ask for the nurse on call. Help is available 24 hours a day, 7 days a week. The nurse will talk with you on the phone and/or come to visit. She will talk with the doctor, if indicated, and they will decide if going to the hospital is necessary.
"Will Medicare/Medicaid/Champus coverage pay for the hospital stay?"
Yes, they will if certain conditions are met:
- The hospitalization has been determined to be necessary. Necessity is assessed by our hospice nurse prior to admission. If needed, she will see the patient at home, assess the situation, and contact the physician to request hospitalization. OUR NURSE MUST ASSESS THIS NEED BEFORE ADMISSION TO THE HOSPITAL.
- The need for hospitalization by hospice must be a condition related to the terminal illness. If it is non-related, regular Medicare/Medicaid/Champus will cover the stay under routine benefits.
- The hospitalization must be needed because the care or treatment cannot be provided in the home.
"Who will make the hospital arrangements?"
If it is necessary to hospitalize the patient, our nurse and/or social worker will make the necessary arrangements.
"Will the Hospice staff visit in the hospital?"
Yes. A Hospice nurse will visit the patient in the hospital. Hospice staff will help plan the patient's return home.
Please follow the above procedures. It will assist you with uncomplicated hospital admissions and help prevent incorrect billing. You will be responsible for payment of hospitalizations and emergency room visits which have not been approved by Blue Ridge Hospice. Please call (540) 536-5210 with any questions or concerns.
Commercial Insurance Coverage
Each commercial insurance policy provides varying levels of coverage for Hospice care. It is very important for patients and their families to be aware of the amount they may be responsible to pay for Hospice care dependent upon the coverage available through their commercial insurance policy, annual deductibles, and co-payments. Blue Ridge Hospice participates with several commercial insurance companies, but not all. Even though your policy may state Hospice care is covered at 100%, if Blue Ridge Hospice is not a participating provider, the coverage will be different than stated. If a patient has Medicare as secondary coverage, Medicare can be billed for any remaining balances not covered by the primary insurance carrier.
Regardless of the percentage that your insurance carrier will cover for Hospice care, the services provided by Blue Ridge Hospice will meet all federal and state regulations.
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