For Providers Making Hospice Referrals

Hospice care at Johnston Health provides comfort and support for your patients with a life expectancy of six months or fewer. Review information about patient eligibility, billing and reimbursement, and the benefits of hospice care.

Patient Eligibility

Your patients may qualify for hospice care if they have significant, documented decline in physical health and abilities due to end-stage disease or refusal of treatment for advanced disease. View detailed hospice admission criteria and guidelines for end-of-life conversations.

If your patient’s health improves after entering hospice care, we’ll discharge them. There is no penalty for early referral.

Why Make Hospice Referrals?

Patients who receive hospice care are less likely to be hospitalized in their final days of life than those who do not, according to a study by the Center for Gerontology and Health Care Research. Many families of hospice patients report wishing hospice care had started sooner, so they and their loved one could benefit from the services and support.

Medicare Coverage

When your patient elects hospice, they assign their Medicaid payments to hospice and agree to the care and services needed based on review and discussion with the Interdisciplinary Team directing their care.

Attending Physician Reimbursement

If you’re an attending physician not employed by our hospice, you continue to bill Medicare for services with the same ICD-10 and CPT codes you previously used. Your patient can keep receiving care from you for any illness. However, any physician providing services in the SECU Hospice House must have Medical Staff privileges with Johnston Health, be a member in good standing, have taken the IP Hospice Physician EMR training and be available for immediate consult 24 hours per day, seven days per week.

Hospice Benefit Periods

Patients have two 90-day periods and then continuous 60-day benefit periods for physician recertification of terminal illness. For the first 90-day benefit period, both the hospice medical director and the patient’s attending physician must certify the patient. For all later benefit periods, only the hospice medical director must recertify the patient. For the first 90-day benefit period and all 60-day periods, there must be a face-to-face examination of the patient by a physician. Additionally, all periods require a Certification of Terminal Illness.

If a patient improves and no longer has a terminal diagnosis, they can leave hospice care and restart later.