Medicare statement saying $0 is covered for hospital bill because of Hospice

I work for hospice. If the hospitalization was RELATED to his hospice diagnosis, then Medicare will not pay, the hospice will be responsible for paying it. If it was not related, then Medicare will pay. What should happen is that Medicare should have sent the bill to hospice to be paid, and then hospice should either pay it or resubmit to Medicare if it was for an issue unrelated to the hospice diagnosis. You need to take the bill to the hospice office and have their revenue coordinator or billing person resubmit to Medicare.

I don't know all the answers, but hospice is supposed to limit hospital care, and we were told that meds not for the hospice diagnosis would not be covered. We would have paid for Moms Sinemet for example. I would guess that you could file an appeal of the ill on the grounds he needed the hospital stay for a painful condition related to his hospice diagnosis that was not manageable in a lesser setting. I hope that is helpful, because that's a horrendous bill to be stuck with!

Joyce, my mom was in hospice service for over 10 years! Medicare covered it 80% and her secondary covered the 20%. It's all about following their strict procedures. Medicare will cover hospice for a limited time. When the time is running out, and if the doctor believes the patient needs ongoing hospice service, the doctor will fill out a form requesting this. Otherwise, the current orders end. and then you will need to re-apply for hospice. You cannot shortcut when it comes to Medicare. You need to figure out who ordered the hospice service, and follow up with them about the rejection and Medicare. Vstefans, there IS instructions on the back of the Rejection notice from Medicare on disputing their findings.

Bookluvr, I stopped using Chrome. I had too many problem w/ my computer (I am guessing because my laptop is older, works fine on my husband and daughter's computers). It can get very aggravating I know.
There was a volunteer that came to give him a bath from Hospice. We considered that the only real help. FIL had a helper that came in every day and expressed concern many times to the hospice nurse about the sores on his legs (diabetic). She would wrap them and while she was doing so would ask the hospice nurse, "is this okay....and can you take a look at this because it looks really infected." The nurse would say, "oh yeah, you're doing it find, looks fine, bye." When FIL went to the hospital , the nurse on duty said he had never taken so much fluid off of a patient. They then asked me if FIL had skin grafts. I said no and asked why. They said, "his legs are so badly infected and in such bad shape, we thought he had skin grafts." We later found out he had MRSA, which has since been treated.
The nurse also would schedule a meeting with my husband and tell him, "I really need to meet with you to discuss important information about the progress of your dad." My husband told her he would have to lay off work for the meeting. He would then get to his dad's house and receive a call that she was going to be an hour or so late. Then she would show up and say, "hi, everything is the same, we are giving him more pain pills." Then walk out.
A chaplin showed up in a mini-skirt and said she was, "whatever religion my FIL needed her to be."
We had a 24 hour number which in our case was essentially an answering service.
They insisted my FIL get a hospital bed which he didn't want. So we had to move the majority of furniture out of the living room. He used it once and then went back to his recliner. They said that since we had a young child around FIL (she is 8) that they would bring in counselors, etc. to help her. Never was mentioned again.
I have helped caregive for 3 other people. All who died without Hospice. These were people who were sick for many years. It was actually easier than the experience we had.

My dad was on Medicare, in a NH, for a certain period of time. Medicare then dropped my dad (this was expected and I was in the process of getting my dad approved for Medicaid). The way we understood it, when we enlisted the help of hospice for my dad we were agreeing that we didn't want anymore medical intervention on his behalf unless it entailed comfort measures and comfort measures only. During hospice, we were still trying to get my dad approved for Medicaid. Had my dad wanted a hospital and had we taken him to the hospital our service with hospice would have been discontinued and my dad would have been charged for services he received at the hospital. And since Medicare had dropped my dad previously my dad would have been on the hook for that bill.

If he was on hospice at the time he went in the hospital, Hospice is responsible for the bill. They take over management of the medicare/medicaid or other insurance when they come in. Sorry you had a bad experience. Hospice is generally a very good service and should be in 6 months or more prior to death. They are very caring and helpful. Most people have misconceptions of what hospice is. They don't come in and take over the care, they don't stop other medications, or stop feeding them etc. Pain management is definitely a focus. A nurse will be in usually once a week to check on the family. An aid may be able to come in for a few hours a day to do personal care. They cover equipment and medications related to the terminal disease for free. They also have volunteers, spiritual help and education for the caregivers. You can opt out of hospice at any time and resume your health ins. and treatments if you wish.

Joyce, I don't understand what you mean by your question to hospice about whether it was a facilitate to die organization, and you were told no. You will need to appeal the Medicare decision but be very careful how you word your objection. It would need to be in agreement with whatever you may have to take to court because you may have a legal cause of action against the hospice group for and rolling you under false pretenses. Medicare sets the rules for hospice so I think they are fairly standard in all the states. I have had direct experience with Hospice in California. Here, in order to be on hospice, a doctor has to certify that they have 6 months or less to live in his or her medical opinion. The condition for which the patient is in hospice is also specified. Usually the term is 6 months at a time, either cancelable or renewable as the conditions warrant. During the time with in hospice, you are not allowed to treat the patient for the condition named as the hospice reason. You are allowed only together palliative or comfort care - pain medication, oxygen, etc. lf the pain becomes more severe, Hospice is allowed to increase medication even to the point of decreased respiration which can and will lead to the patient passing away. I kind of consider this facilitating doubt, don't you? And that's OK as long as that's what you wanted. But if that's not what you wanted, and you were told otherwise, you see where the false pretences may come in.

What you ARE allowed to do under hospice is treat a condition that is NOT the cause of the hospice evaluation. For example, if the patient is in hospice for Alzheimer's and becomes worse, you can't do anything to trade the Alzheimer's. BUT if the patient comes down with pneumonia, you don't have to but you CAN treat the pneumonia. AND it can be done at the hospital. Because we never had this circumstance, I don't know who pays but I presume it would be regular insurance, not Hospice. The rules for payment by disciple national company is generally that it has to be Medicare approved, so if Medicare doesn't approve the charge, the supplemental won't have to pay either. Medicare COULD approve the charge but page ZERO, in which case the supplemental should pick up the rest.

There are some intricate points at play in this case and since &18 thousand is at stake, you may want to consult with a lawyer before you write the Medicare appeal. As I said above, your complaint will have to be the same incase Medicare denies and you have to file a lawsuit, you can't change your stories in midstream.

as usual, corrections...I apologize that my android voice recognition is so lame

legal cause of action... for ENROLLING your dad under false pretenses

during the time WHILE UNDER Hospice

allowed only TO GIVE palliative

consider this facilitating DEATH, don't you?

you can't do anything to TREAT the Alzheimer's

rules for payment by THE SUPPLEMENTAL INSURANCE company

approve the charge but PAY zero

Since $18,000 is at stake.
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RE: HOSPICE

I would like to add there's a world of difference between groups. Our hospice had nurses on call who were in direct communication with the doctor, managing and upgrading patient medication, I health care worker 2 times a week who helped with showering or gave them a bed bath is the case was, and for my mom who just passed in January, the hospice nurse decided my mom was 'critical care' and provided LVNs round the clock 45 days while she was dying. Plez get a list of Hospice is from the hospital, talk to a couple of discharge case managers who work with the hospuce is all the time (since you often are getting a hospice evaluation in the hospital before discharge), and do some interviewing about their services prior to when you need them. IMHO, on top of everything else, you had a lousy Hospice.

Gather your paperwork, check to see why your dad was in hospice, was it for pain because of cancer, for trying to kill himself (a psych problem). Surely a building up of urine (which produces its own pain as well as becoming a medical emergency) and the inability of a nurse to properly cath him, can't in and of itself becoming cause to make someone hospice appropriate? I no I'm not aware of the entire case but this just sounds off to me.

Like every other service there are good and bad hospices and good and useless nurses within each.
The Medicare regulations that have to be followed are very strict. the Hospice receives a daily rate of payment for each patient and it is often difficult to pay for everything the patient needs within that amount. Some young patients use their primary insurance as long as it has a hospice benefit, otherwise they pay out of pocket on a sliding scale. many hospices hold fundraisers to help defray their costs. Hospices nurses typically are paid less than their hospital counterparts and receive lower benefits. making ends meet is a constant juggling game which explains why certain supplies are sometimes in short supply
The be eligible for hospice the patient must be certified to have a condition that can be expected to lead to death in six months or less. The MD must certifiy this and often will do so as long as they have seen the patient within the last six months. Often a patient's PCP will be a FNP or PA and the MD will never have actually seen the patient. an MD other than the PCP cansign the paperwork as long as they have been seeing the patient and often this will be someone like an Oncologist or renal specialist. Every cost associated with the terminal illness will be covered by hospice at their discretion so if you decide you want to go to the ER for some reason and it is not cleared with hospice first they won't pay.
Putting a catheter in a male patient can be very difficult if not impossible because elderly men tend to have enlarged prostates so there is no shame in not being successful at inserting a catheter but it is easy enough to check the patient for an overfull bladder and take him to the hospital where an MD can evaluate and treat. Hospice will usually pay those costs but if he refuses to come home when ready for discharge, hospice has the option to discharge him from their service. Hospice will continue to care for patients in hospital usually for five days when they will have either died or are waiting for nursing home placement. Hospice is able to continue to care for patients in N/H but only if the N/H allows it and many don't. If the patient leaves hospice normal nursing home Medicare/ Medicaid regulations apply.
Patients can be discharged from hospice if their condition improves and later be re-admitted for the same or another condition. The hospice may pay for things like radiation or chemo as long as it is of a palliative nature for example to shrink a brain tumor and relieve symptoms.
As most people know Medicare/Medicaid and any kind of health insurance can be an absolute minefield so question, everything, do your own research and demand answers which is not easy when you are dealing with end of life issues so the best advice is to be proactive when there is a family member with a chronic illness. Good wishes to all those doing and who have made the selfless sacrifice to care for a loved one.

jmcgrath - "If he was on hospice at the time he went in the hospital, Hospice is responsible for the bill" is true only if the hospitalization was related to the terminal diagnosis. And the hospice organization should work with you to make sure the bill is accepted by Medicare for payment if not (related to terminal diagnosis). I work for a not-for-profit hospice in the Midwest and am appalled at what I am reading! In my 11 years with hospice I have never seen any of the abuse and lack of compassion expressed in some of these comments. It takes the signatures of TWO physicians - not nurse practitioners nor physician assistants - to qualify for the first 90-day Hospice Medicare Benefit along with documentation and supporting medical reports. It then requires more documentation and physician signatures for the second 90-day benefit. After that, a face-to-face meeting between the patient and either a physician or nurse practitioner is required to continue your HMB in 60-day increments, each proving that the patient remains hospice appropriate.
My heart goes out to those families that not only had the heartbreak of losing a loved one while on hospice services, but then they also had horrible services with their hospice organization.