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PAP353

Hospice Coordination


Provider Administrative Policy

Section
Ancillary Provider
Policy Date
August 2008
Status/Date
New/August 2008
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Hospice Coordination

There may be occasions when providers will need to coordinate quality hospice care to members.

Hospice Definition
Support and care for persons in the last phase of an incurable disease so that they may live as fully and comfortably as possible.

Hospice Eligibility
For hospice eligibility, a member must:

  •  Have received a diagnosis of terminal illness with a life expectancy of six months or less
  •  Reside within the local geographical area of an approved hospice to ensure access to care and adequate  services
  •  Have a designated primary caregiver available to provide supportive care in a home setting at all times
  •  Be formally accepted by an approved hospice
  •  Possess a contract that includes hospice benefits for which Blue Cross of Idaho has primary liability
  •  Ensure the hospice plan of treatment is approved by Blue Cross of Idaho"s Medical Management Department

Covered Hospice Services
Because the hospice authorization/per diem allowance includes the routine hospice services identified below, you cannot submit separate claims for these services:

  •  Doctor services
  •  Nursing care
  •  Emergency room visits
  •  Ambulance services
  •  Medical equipment (such as wheelchairs or walkers)
  •  Medical supplies (such as bandages or catheters)
  •  Drugs for symptom control and/or pain relief (by any delivery method)
  •  IV Hydration (including TPN)
  •  Home health aide and homemaker services
  •  Physical and occupational therapy
  •  Speech therapy
  •  Social worker services
  •  Dietary counseling
  •  Grief and loss counseling
  •  Short-term inpatient care
  •  Short-term respite care
  •  Any other covered services needed to manage pain and other symptoms related to hospice diagnosis as recommended by hospice

A hospice provider should have established arrangements with local skilled nursing facilities and hospitals in the event a hospice-related diagnosis requires inpatient respite care or general inpatient care.

If a hospice patient receives treatment for a condition separate from the hospice diagnosis, you can submit a separate claim for that treatment. For example, if the patient receives treatment in the emergency room for a fractured hip but is under Hospice for colon cancer, you can file a claim for the services related to the fractured hip.

Services Not Related to Hospice Authorization
A hospice provider is required to notify Blue Cross of Idaho immediately of any change in a patient"s condition or plan of treatment that may affect the patient"s eligibility for hospice care benefits (Inpatient hospitalization for a broken hip).


Policy History

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