Provider Resources

Your Patient’s Journey to Peace Begins With Us.

Our hospice team can admit patients within 24 hours of a referral.
Contact 540.741.3580 or hospice.intake@mwhc.com.

Mary Washington Hospice

Hospice is a unique and compassionate form of care and support for individuals facing life-limiting illnesses. At Mary Washington Hospice, we've learned that starting hospice care early brings more meaning and benefit to patients, caregivers, and loved ones. We prioritize the comfort and dignity of our patients, managing their pain and symptoms to facilitate decision-making. Our support extends to families, helping them navigate the challenges of end-of-life logistics while coping with the illness and loss of a loved one. We also engage in thoughtful conversations with patients, ensuring their final days are peaceful and spent with family and loved ones.

We can admit a patient to our hospice program within 24 hours of receiving a referral.

Eligibility

Patients of all ages with a prognosis of 6 months or less, following the usual course of their disease. Patients must forego Medicare coverage for curative treatments related to their terminal illness.

Primary Goals of Hospice Care

Enhancing the quality of life and alleviating suffering, encompassing physical, emotional, and spiritual aspects.

Interdisciplinary Team Approach

Our team includes physicians, nurses, social workers, chaplains, expressive therapists, and volunteers, in accordance with statutory requirements.

Appropriateness for Hospice Services

Patients can remain in hospice care as long as they meet the criteria. The patient's care plan is regularly reviewed for appropriateness by our interdisciplinary team, including the attending physician.

Payment/Coverage

Hospice services are covered by Medicare, with commercial payers often following a similar model. Medicaid coverage varies by state, and medication costs related to terminal illness are typically included.

Places of Care

Our care can be provided in various settings, including homes (most common), assisted living facilities, nursing homes, residential hospice facilities, inpatient hospice units, or hospice-contracted inpatient beds. Our goal is to enable patients to stay in their place of residence whenever possible.

How to Refer

For a hospice services consultation or for more information, please call 540.741.3580 or e-mail hospice.intake@mwhc.com.

Hospice Care Consult includes:

• Estimated life expectancy less than six months.
• Qualifying terminal diagnosis.
• Hospice is a service, not a specific location, so patients must have a place of residence to receive services.
• We offer intermittent RN, social work, and bereavement support, along with Certified Nursing Assistant (CNA), chaplain, therapy services, and volunteers as needed or requested.
• Bereavement support is available to the family for 13 months following the patient's passing.
• Patients may require varying levels of care based on clinical needs, including respite, general inpatient (GIP), and continuous care.
• Our hospice RN is available 24/7 to respond to patients, families, and physicians.

Hospice Consult Examples:

1. Family decisive and authorizing extubation due to futile aggressive interventions; family seeking comfort care measures only.
2. End stage heart disease optimally treated or is not a candidate for surgical intervention (CHF NYHA class IV or EF <20%).
3. Progression of end stage lung disease with frequent ED visits or hospitalizations for infections, respiratory failure.

Hospice care appropriateness is based on the patient’s symptoms and the complexity of symptom management.

Advance Care Planning (ACP) Billing Guide

Face to Face Advance Care Discussion*

Face to face service between a physician or other qualified healthcare professional (QHP) and a patient, family member or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.

Advance Directive per CPT

Per CPT, an advance directive is defined as a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.

Documentation Required

While CMS did not identify documentation requirements, consider documenting relevant aspects listed below when applicable:

• Identify patient, family member and / or surrogate, and others present for discussion.
• Describe existence or completion of any and all legal documentation including durable power of attorney for health care / health care proxy, medical orders of life-sustaining treatment, physician orders for life-sustaining treatment, Living Will, etc.
• Patients health care / medical care preferences (priorities, goals and values that would influence future medical care, worries and concerns that may direct medical care, type of care and setting preferred, type of care patient would never want).
• Discussion and questions related to goals of care, advance directives and the designation of a health care decision maker.
• Document “Start” and “End” time, and “Total ACP” time.

* Since January 1, 2016, Medicare has reimbursed physicians for time spent engaged in face-to-face conversations with their patients about advance care planning.

Duration of ACP Discussion and Appropriate ACP Codes:

• First 30 minutes: 99497
• 31–60 minutes: 99497 + 99498
• 61–90 minutes: 99497 + 99498 x2
• 91–120 minutes: 99497 + 99498 x3

ACP Codes cannot be billed with critical care codes.
ACP codes CAN be used with Evaluation and Management code if the services were rendered.

Frequently Asked Questions (FAQs):

1. Can ACP codes be billed with Critical Care codes? NO
2. Can ACP codes be used with Evaluation and Management codes? YES
3. Are there any locations where ACP codes cannot be used? NO
4. Are there limits on how often ACP codes can be billed? NO
5. Does an Advance Directive have to be completed in order to bill ACP? NO

References

https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-28005.pdf, p199, pp240-254