Everything Physicians Should Know About Palliative Care Medicare Coverage

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Everything Physicians Should Know About
Palliative Care Medicare Coverage
Basics of Palliative Care Palliative care plays
a crucial part in improving the physical, mental,
social, and spiritual quality of life for those
with serious or life-threatening illnesses. When
diagnosed with a serious illness, Medicare
beneficiaries might choose to receive palliative
care in addition to any other ongoing treatments.
In this case, palliative care aims to maintain
quality of life throughout the illness.
Palliative care Medicare coverage includes
long-term illnesses and hospice care for terminal
illnesses. Billers often confuse between
palliative care and hospice care. If a patient
has been diagnosed with a terminal illness with
less than 6 months to live, they may seek hospice
care. Medicare beneficiaries with serious
illnesses can choose palliative care to retain as
much of their quality of life as
possible. Palliative care addresses patients
physical, intellectual, emotional, social, and
spiritual needs. Palliative care supports with
independence, access to information, and the
ability to make choices about their health care.
Working with a palliative care specialist allows
Medicare beneficiaries with serious illnesses to
maintain their physical, emotional, and spiritual
quality of life. Palliative care Medicare
coverage includes inpatient care, outpatient
care, and mental health counseling.
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Everything Physicians Should Know About
Palliative Care Medicare Coverage

• Some of the serious illnesses that may benefit
  from palliative care include Alzheimers disease
  amyotrophic lateral sclerosis (ALS) cancer
  chronic obstructive pulmonary disease (COPD)
  congestive heart failure dementia end-stage
  liver disease end-stage renal disease HIV/AIDS
  Huntingtons disease multiple sclerosis
  Parkinsons disease sickle cell anemia stroke.
• Palliative Care vs. Hospice Care
• The slight difference between palliative care and
  hospice care as follows
• Hospice care Hospice care is end-of-life medical
  care that provides emotional and physical support
  for patients with terminal illnesses. It is
  reserved for those with a life expectancy of 6
  months or less. It focuses on relieving the
  symptoms of the illness, supporting the persons
  emotional and spiritual health, and helping with
  any important decisions regarding the end of
  life. When you receive hospice care, it takes the
  place of any curative or life-prolonging
  treatments you would otherwise receive.

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Everything Physicians Should Know About
Palliative Care Medicare Coverage

• Palliative care This focuses mainly on improving
  patients well-being in case of having a serious
  illness. Palliative care offers a support system
  to patients and their families so they can
  continue to have a good quality of life. Unlike
  hospice care, Medicare beneficiaries in
  palliative care continue to undergo curative or
  life-prolonging treatments.
• Palliative care and hospice care both focus on
  supporting overall well-being when the patient
  has a serious illness. However, hospice care is
  reserved for the end of life, when patients have
  chosen not to have any further treatments to cure
  their illness.
• Palliative Care Medicare Coverage
• Original Medicare and Medicare Advantage both
  cover palliative care, both with and without
  hospice care, when its deemed medically
  necessary. Heres what each part of Medicare
  covers
• Medicare Part A Palliative Care Coverage
• Medicare Part A is hospital insurance. It covers
  many of the inpatient and skilled care needed
  with palliative care. Under Part A, Medicare
  beneficiaries are covered for

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Everything Physicians Should Know About
Palliative Care Medicare Coverage

• Inpatient hospital stays This includes any
  treatments or services Medicare beneficiaries
  might need during their stay.
• Short-term stays at an SNF Services include
  rehabilitation services, medication
  administration, and other day-to-day care.
• Limited home health care includes part-time
  skilled nursing or home health aide care and
  rehabilitation services.
• Hospice care Medicare beneficiaries are covered
  for any palliative care necessary for comfort at
  the end of life.
• Medicare Part B Palliative Care Coverage
• Medicare Part B is medical insurance. It covers
  most of the outpatient services that are needed
  during palliative care. With Part B, Medicare
  beneficiaries are covered for
• Doctors appointments These may be needed for
  the diagnosis, treatment, and prevention of the
  illness or other related conditions.

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Everything Physicians Should Know About
Palliative Care Medicare Coverage

• Durable medical equipment This includes any
  equipment that may be needed for treatment or to
  make patients more comfortable.
• Mental health counselling Emotional support and
  counseling may be needed for patients or their
  loved ones during your care.
• Rehabilitation therapy (as an outpatient) This
  includes speech therapy, physical therapy, or
  occupational therapy as needed.
• Medicare Advantage Palliative Care Coverage
• Medicare Part C is also known as Medicare
  Advantage. This is a Medicare option sold by
  private insurance carrier companies. With
  Medicare Advantage, Medicare beneficiaries are
  automatically covered for the same services as
  Medicare Part A and Part B, including those for
  palliative care. Under Medicare Advantage,
  Medicare beneficiaries might be covered for some
  additional services, such as
• Prescription drugs These may be for treatment or
  to help ease any symptoms.
• Long-term care may include skilled healthcare
  services or help with everyday personal needs,
  such as bathing, dressing, or eating.

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Everything Physicians Should Know About
Palliative Care Medicare Coverage
Private payers that sell Medicare Advantage plans
may also offer different plan options to fit
individual needs. For people with serious
illnesses, Special Needs Plans (SNPs) offer
additional medical services and flexibility that
may better for long-term or serious
conditions. Medicare Part D Palliative Care
Coverage Medicare Part D is prescription drug
coverage. Part D may cover medications needed
during palliative care. Some of the conditions
during palliative care for which medications are
prescribed are anorexia, anxiety, constipation,
delirium, depression, diarrhea, dyspnea, fatigue,
mucus buildup, nausea, pain, and vomiting.
Medications for these conditions may include
antidepressants, anxiolytics, antipsychotics,
stool softeners, antidiarrheals, and opioid and
nonopioid analgesics. If Medicare beneficiaries
are receiving hospice care, most medications are
covered under the hospice benefit with a 0 to 5
co-payment per prescription drug. Medications
that arent covered under the hospice benefit may
still be covered under a Medicare Part D
plan. Receiving Palliative Care
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Everything Physicians Should Know About
Palliative Care Medicare Coverage

• When a patient is diagnosed with a serious
  illness, the primary care physician helps to get
  in touch with a palliative care specialist.
  Palliative care specialists help build a team of
  other specialists to coordinate the many aspects
  of patient care. The palliative care specialist
  will review this information to create a
  personalized team and plan. For example, a
  palliative care team may include a palliative
  care doctor, counsellor, pharmacist, and
  dietitian. Working together, they may create a
  plan that involves weekly therapy sessions, a
  specialized medication plan, and a personalized
  meal plan. All of these services can help
  increase your quality of life during a patients
  illness.
• If Medicare beneficiaries are receiving
  palliative care without hospice care, theyll owe
  standard Medicare out-of-pocket costs. These
  costs generally include
• Deductibles In 2020, Medicare beneficiaries were
  paying 1,408 per benefit period for Part A and
  198 per year for Part B.
• Co-payments These may include out-of-pocket
  costs for prescription drugs and Medicare
  Advantage doctors visits and specialist visits.

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Everything Physicians Should Know About
Palliative Care Medicare Coverage

• Coinsurance Depending on the length of inpatient
  care, Medicare beneficiaries might pay some
  coinsurance costs each day under Part A, 20
  percent of the costs for services under Part B,
  and any costs related to prescription drugs.
• If the beneficiary has a Medicare Advantage plan,
  they may also owe additional premium, deductible,
  co-payment, and coinsurance costs.
• Medicare beneficiaries who are seeking for
  palliative care can get in touch with your doctor
  who can further help in getting connected with
  palliative care experts. Medical Billers and
  Coders (MBC) is a leading medical billing company
  providing complete medical billing and coding
  services. In this article, we shared essential
  information on palliative care Medicare coverage
  for provider education purposes. Primary care
  physicians who are seeking assistance in medical
  billing and coding can call us at 888-357-3226 or
  drop an email at info_at_medicalbillersandcoders.com
  .