“Acute inpatient care is when the patient's pain or other symptoms are not manageable in the home. Examples include continuous seizures or vomiting, uncontrollable agitation and extreme pain. Inpatient care takes place in a hospital or hospice facility. There is no specific time limit for acute inpatient care, but the Medicare benefit stops paying after controlling the symptoms…”
To receive payment for “general inpatient care” under the Medicare hospice benefit, beneficiaries must require an intensity of care directed towards pain control and symptom management that cannot be managed in any other setting. While there is nothing prohibiting a Medicare approved facility from serving as the individual's home, it is the level of care provided to meet the individual's needs which determine payment rates for Medicare services. “Caregiver breakdown” should not be billed as “general inpatient care” regardless of where services are provided, unless the intensity-of-care requirement is met. If the individual is no longer able to remain in his or her home, but the required care does not meet the requirements for “general inpatient care”, hospices should bill this care as “inpatient respite care”, payable for no more than 5 days, until alternative arrangements can be made.
For assistance with individual patient situations, contact the Case Management Department.
Knowledge Resources, Vassar Brothers Medical Center | 45 Reade Place, Poughkeepsie, NY 12601 | 845.437.3121