Can You Bill Medicare for Home Health Care if Getting Hospice Care?

Medicare Part A contains benefits for both home health services and hospice care. Hospice care is provided to terminally ill people within the last six months of life. It focuses on the patient's comfort and dignity rather than aggressive treatment, and is generally supplied at the patient's home. Technically home health and hospice are two different benefits, but most hospice services are provided at the patient's home. If they meet certain conditions, home health care needed because of hospice will be covered under Medicare Part A.

Choosing Hospice

• In order to qualify for Medicare hospice benefits, both a doctor and the director of the hospice must certify that the patient is not expected to live longer than six months. The patient must also explicitly state in writing that she chooses hospice care over other kinds of medical services. In addition, all hospice services must be received through a provider approved by Medicare. If these conditions are not met, Medicare will not honor the claims.

Covered Hospice Services

• Medicare covers many different kinds of services under the Part A hospice benefit. Covered services include social worker assistance, dietary counseling, loss and grief counseling for both the patient and the family, nursing care, durable medical equipment such as wheelchairs, medical supplies, pain-relief medications, home health aides, nursing care and doctor services, as long as they are required by the terminal illness and any related conditions. Medicare also still cover any health problem unrelated to the terminal illness under standard Medicare rules.

Hospice Services Not Covered

• All medical services a patient may need while receiving hospice care are not necessarily covered by the hospice benefit. Once a patient has chosen hospice, home health and other medical services meant to cure the terminal illness rather than provide palliative care will not be covered. Prescription drugs meant to cure instead of relieve pain will also not be covered, nor will any services at all which come from a hospice provider other than the one already chosen by the patient.

Stopping Hospice Care

• Patients can change their minds at any time about receiving hospice care. If so, their Medicare coverage will return to what it was before hospice and the patient will be able to seek aggressive treatment again. However, home health services will also fall under regular Medicare rules and will not be covered unless the patient is deemed homebound, a doctor approves it and creates a home health care plan and the patient needs only part-time nursing care or therapy.