Insurance Billing

Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet ALL of the following conditions:

  • You are eligible for Medicare Part A
  • Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live
  • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness
  • You receive care from a Medicare-approved hospice program

Each October, Medicare informs every hospice of the rate in which we will be reimbursed, based on the county the patient resides in. We do not set the rates. We are paid a daily per diem which covers the following, when the services are medically necessary and have been pre-approved by Mercy Hospice and a contracted facility or supplier is used.

  • Nursing care
  • On-call nurse available 24 hrs a day, 7 days a week
  • Necessary medical equipment (like wheelchairs or beds)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control and pain relief
  • Short-term care in the hospital
  • Short-term respite care in a skilled nursing facility, up to five days at a time
  • Certified Nurse’s Assistant services
  • Social worker services
  • Chaplain services
  • Physical therapy
  • Dietary counseling
  • Grief and loss counseling to help your family for one year

The following are the 2007-2008 Medicare rates Hospice receives for persons eligible for the Medicare hospice benefit in Horry County:

  • Routine Home Care, $129.51 per day
  • Inpatient Respite Care, $135.20 per day
  • General Hospital Inpatient Care, $577.82

Medicaid

Medicaid also has a hospice benefit for those with a terminal illness. You may be able to receive this benefit if:

  • You are eligible for Medicaid.
  • Your doctor and the hospice medical director certify that you are terminally ill and have less than six months to live
  • You sign a statement choosing hospice care instead of routine Medicaid covered benefits for your terminal illness (You may not be enrolled in a Medicaid Managed Care Program)
  • You receive care from a Medicaid approved hospice program

Each year, Medicaid informs every hospice of the rate in which we will be reimbursed, based on our location. We are paid a daily per diem which covers the following, when the services are medically necessary and have been pre-approved by Mercy Hospice and a contracted facility or supplier is used.

  • Nursing care
  • On-call nurse available 24 hrs a day, 7 days a week
  • Necessary medical equipment (like wheelchairs or beds)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control and pain relief
  • Short-term care in the hospital
  • Short-term respite care in a skilled nursing facility
  • Certified Nurse Assistant services
  • Social worker services
  • Chaplain services
  • Physical therapy
  • Dietary counseling
  • Grief and loss counseling to help your family for one year after the death

Veterans Benefits

Hospice care is covered under the Veterans Benefit. You are eligible for hospice benefits when you meet ALL of the following conditions:

  • You are eligible
  • Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live
  • You sign a statement choosing hospice care instead of routine VA covered benefits for your terminal illness
  • You receive care from a government-approved hospice program

If the patient has both Medicare A and VA benefits, they have the option of choosing which hospice benefit they would like to elect—either Medicare’s or the VAs.

Each VA office is different but some will pay hospices at Medicare’s Routine Home Care level, rather than “fee per service”. If the VA office allows this billing method, the following services will be covered by hospice.

  • Nursing visits
  • On-call nurse available 24 hrs a day, 7 days a week
  • Necessary medical equipment (like wheelchairs or beds)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control and pain relief
  • Certified Nurse’s Assistant services
  • Social worker services
  • Chaplain services
  • Physical therapy
  • Dietary counseling
  • Grief and loss counseling to help your family

Please contact your VA casemanager to determine how they handle paying hospices for care inside the home. Currently, the Charleston, South Carolina VA office will pay local hospices Medicare’s Routine Home Care rate of $129.51.

At this time, unfortunately, the VA will NOT pay hospices for inpatient hospital stays or respite care stays, like Medicare Part A does. If a patient requires respite care, emergency services, or an inpatient hospital stay, the VA Casemanagement Department states that they must be notified so that they have the opportunity to coordinate these services.

If the patient needs emergency care services, the VA will likely deny the hospital claim. The patient or primary caregiver is responsible to work with the hospital to appeal the VA’s denial of the claim. If the VA determines that emergency services were not justified, the claim will become the responsibility of the patient.

Commercial Insurance

Mercy Hospice accepts private insurance payments. Each insurance program is different. Our staff will check with your insurance carrier prior to admission to make sure that hospice care is covered. Some insurance carriers will only pay “per visit”. Other times, their casemanager may ask us to accept a “per diem arrangement” in which we are paid a daily rate to include certain services.

When co-pays and deductibles have not been met, a statement will be sent to the family. If this creates a financial hardship, please speak to your assigned Mercy Hospice social worker. She can assist you in completing an application to receive financial assistance.

No Insurance

Mercy Hospice admits patients to the Hospice program based on need and regardless of their ability to pay, unlike many for-profit hospices in the area. Charitable donations from memorials, churches, fundraising events, and civic clubs allow us to provide Hospice services to those patients without a payment source.

These services may include:

  • Nursing care
  • On-call nurse available 24 hrs a day, 7 days a week
  • Medical supplies (like bandages and catheters)
  • Certified Nurse’s Assistant services
  • Social worker services
  • Chaplain services
  • Dietary counseling
  • Grief and loss counseling to help your family

Mercy Hospice is not responsible for any other costs, such as hospitalization, medications, medical equipment, physician visits, lab work, or x-rays.

If you would like more information, please contact:

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