Medicare Compliance & Reimbursement

Tip: Hospices aren’t the only provider type that can earn extra reimbursement.

A new model program could rapidly change the landscape of providing hospice and palliative care along with treatment services to Medicare and Medicaid beneficiaries. Soon your patients will no longer be forced to choose between receiving either palliative care or curative treatments.

Would Your Patients be Interested?

Although both Medicare and Medicaid cover hospice care, a beneficiary is no longer eligible to receive curative care when he chooses hospice care. The Medicare Care Choices Model (MCCM) aims to change this paradigm, and the Centers for Medicare & Medicaid Services (CMS) recently announced the awards for participants in this model.

On July 20, CMS announced MCCM awards to 141 Medicare-certified hospices, which far exceeded its original selection limit of 30 hospices. CMS expanded the MCCM enrollment due to overwhelming interest in the model from hospices. The increased participant roster will allow up to 150,000 beneficiaries to participate in the model, instead of the originally anticipated 30,000 beneficiaries.

According to the National Association for Home Care & Hospice (NAHC), the MCCM project’s goals are twofold:

• To evaluate whether eligible Medicare and dually eligible beneficiaries would elect to receive supportive care services typically provided by hospice if they were able to also receive curative care; and

• To determine whether providing both palliative and curative care concurrently impacts care quality and patient and family satisfaction.

Why Hospice Providers are Enthused

“Under the project, the requirement that terminally ill patients forego their right to curative care for the terminal condition(s) would be waived,” NAHC explains. “It is currently believed that some terminally ill patients do not enter hospice because they want to continue curative care.”

Neighborhood Health of West Chester was one of four agencies chosen in Pennsylvania to participate in the model, and president/CEO Andrea Devoti says that her staff members are looking forward to offering the program to their patients who are dealing with chronic diseases.

“The patients are well enough to remain in the community, yet need support and oversight to ensure they remain in their homes,” Devoti notes. “I believe this program will keep patients healthier and in their homes and allow them when the time is appropriate to easily transition to our hospice program with a comfort level of the care they will receive.”

Of the four agencies which are participating in the model in Missouri, one is Mercy Hospital Jefferson d/b/a Mercy Hospice. The agency’s administrator of home health and hospice, Monica Rozier, says that being selected to participate in the model “is a terrific recognition of the level of care we provide, and a tremendous benefit for patients who qualify.”

“The model is for patients who would otherwise qualify for hospice, but they are not ready to give up on curative treatment,” Rozier explains.

Get Fair Payment for These Services

Payoff: Under the model, CMS will pay participating hospices a per-beneficiary per-month fee of $200 to $400 for delivering services under the model. Services can include those that are currently available under the Medicare hospice benefit for routine home care and respite levels of care that they cannot bill separately under Medicare Parts A, B and D. Such services include:

• Nursing;

• Social work;

• Hospice aide;

• Hospice homemaker;

• Volunteer;

• Chaplain;

• Bereavement;

• Nutritional support; and

• Respite care services.

Other providers will also benefit from the MCCM project — providers and suppliers furnishing curative services can bill Medicare for the services provided to beneficiaries who elect to participate in the model, regardless of their participation in the hospice benefit, according to CMS. Reimbursable services furnished to participating beneficiaries may include:

• Physical or occupational therapy;

• Speech language pathology services;

• Drugs for managing pain or other symptoms from the terminal illness or related conditions;

• Medical equipment and supplies;

• Any other service specified in the patient’s plan of care for which payment may otherwise be made under Medicare (for example, ambulance transports);

• Short-term inpatient care for pain or symptom management that cannot be managed in the home environment; and

• Physician services.

What Types of Beneficiaries are Eligible?

But not all hospice patients are eligible to participate in the MCCM. CMS has put certain restrictions on what categories of Medicare and dually eligible beneficiaries are allowed to participate in the model.

To participate in the MCCM, beneficiaries must:

• Have a diagnosis of a certain terminal illness: advanced cancers, chronic obstructive pulmonary disease (COPD), congestive heart failure, and/or HIV/AIDS;

• Meet hospice eligibility requirements under the Medicare or Medicaid hospice benefit;

• Not have elected the Medicare or Medicaid hospice benefit within the last 30 days prior to their participation in the MCCM;

• Receive services from a hospice that is participating in the MCCM; and

• Have satisfied the MCCM’s other eligibility criteria.

Timeline: Providing services under the MCCM will occur in a phased-in fashion over the course of two years, according to CMS. Half of the participating hospices will start providing services under the MCCM on Jan. 1, 2016, while the remaining half will begin providing services under the model on Jan. 1, 2018. The end date for the MCCM is scheduled for Dec. 31, 2020.

Resource: For more information on the MCCM project, visit http://innovation.cms.gov/initiatives/Medicare-Care-Choices.