Check out the latest updates on Medicare Hospice Reimbursement for 2020 here.
As with many medical costs and reimbursements, hospice reimbursement rates have changed over the past fiscal year. Here are some of the rate changes, prognosis indications and other changes to the reimbursement landscape of hospice care in 2018.
Rate Changes from FY2017 to FY2108
Once again, reimbursement is highly dependent on compliance with reporting standards. You may have already experienced the changes from the FY2017 rates that ended on Sept. 30, 2017, the FY2018 rates went into effect on Oct. 1, 2017, without any rate increases for hospice physician services.
The current base payment rates include:
- Routine Home Care (days 1-60) $190.55 increases to $193.03
- Routine Home Care (days 61+) $149.82 increases to $151.61
- Continuous Home Care Full Rate = 24 hours of care
- Hourly rate of $40.19 increases to $40.70
- Payment rate of $964.63 increases to $976.80
- Inpatient Respite Care $170.97 increases to $181.87
- General Inpatient Care $734.94 increases to $743.55
Additionally, the FY2017 cap was $28,404.99, while the FY2018 cap ending on Oct. 31, 2018, is $28,689.04.
(These are the base rates which vary according to the economic multiplier used for different parts of the country as well as rural vs. urban communities. They are quoted for providers who have submitted the required data.)
Diagnosis vs. Prognosis Updates
Debate continues on the difference between multiple condition diagnosis and overall patient prognosis. Medicare reimbursement focuses primarily on the criteria of prognosis. Among other details, a patient will not meet the conditions for hospice reimbursement care unless:
- A physician and specific clinical findings result in a diagnosis of a terminal condition with a terminal timeline of six months or less.
- The individual provides a signed statement designating the election of hospice care over other treatments related to the terminal prognosis.
- A patient seeks only the designated hospice care as laid out by Medicare for palliative services and disease management.
Unrelated treatment and diagnosis may fall outside the scope of current Medicare Hospice reimbursement policies.
Modern Medicine Changes the Hospice Landscape
As noted previously, hospice care has changed significantly over time. Simply put, as medicine advances, lifespans increase. While hospice patients have a limited projected lifespan, the amount of time spent in hospice care has also increased. Along with this increase in lifespan is also an increase in the number of conditions treated by hospice care. This expansion has increased care costs by an average of $1 billion per year in the United States.