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The Right Time

When is the Right Time to Refer to Hospice?

As a physician, you are familiar with the Hospice Medicare Benefit and the criteria for hospice eligibility for an individual having a life expectancy of approximately six months or less. However, a study by the National Hospice and Palliative Care Organization (NHPCO) reveals that almost one-third of hospice patients die within one week of admission.

The earlier a patient is referred to and receives hospice care, the more opportunity there is to manage pain and symptoms, enhance quality of life and provide support to their loved ones.

Following is a list of commonly asked questions about referring patients to JourneyCare:

What does JourneyCare do that I can’t?

JourneyCare provides an interdisciplinary team of healthcare professionals trained in palliative medicine and hospice care. This team includes doctors, registered nurses, social workers, chaplains and volunteers who support the physical, emotional and spiritual needs of patients and families.

What are some circumstances I should consider when referring a patient to JourneyCare?

The following are guidelines that, along with meeting the criteria for hospice eligibility, are reasons for referring a patient to JourneyCare:

Not Responding to Treatment…

A patient may be undergoing treatments meant to cure the disease, but the patient may no longer be improving despite the treatments, or the treatments may be causing more pain and uncomfortable symptoms than the patient can or is willing to tolerate.

Changes in Goals of Care…

After a patient spends an extended time in the hospital, the decision may be made that he/she would rather be in the comfort of their own home, surrounded by family and friends. They may also be at the point where their condition is getting worse, despite the numerous treatments they are receiving in the hospital. They would rather concentrate on making the most of each day, rather than undergoing another treatment that may make them feel sicker.

If I refer a patient to JourneyCare, can I continue to be involved with the patient’s care?

Of course. As the patient’s physician, you become part of the JourneyCare team and you will be consulted on all aspects of care.

Do I get paid if I continue to see my patient?

Yes. JourneyCare can provide your office staff with the information and codes that you can bill and be paid for your professional services.

How do I bill for Consulting Physician Services for JourneyCare patients?

When a Medicare beneficiary elects hospice care, he/she may designate an attending physician, which is defined by Medicare as the physician or nurse practitioner which is identified by the individual at the time he/she elects hospice coverage as having the most significant role in the determination and delivery of medical care.

If the attending physician is not employed by JourneyCare, the attending physician or nurse practitioner can directly bill Medicare Part B for their services for reimbursement.

When billing Medicare Part B as the “attending physician” or nurse practitioner, the HCPCS modifier GV must be submitted for the services provided in JourneyCare. Services submitted without this modifier will be denied.

Professional services related to the terminal illness provided by any physician other than the attending physician are considered to be “consulting physician” services. The consulting physician must contact JourneyCare for payment of these services. JourneyCare will bill Medicare Part A and reimburse the physician based on a contractual agreement.

The consulting physician must have a signed letter of agreement with JourneyCare. One agreement for a group of physicians is allowed as long as all physicians in that group are listed on the agreement.

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