Potential Medicare Reimbursements for Services to Patients with Chronic Fatal Illnesses

Abstract

Medicare’s payment and coverage patterns most readily serve beneficiaries’ needs for episodic interventions such as surgery and diagnostic tests. Except in hospice, supportive services for long-term, worsening illnesses have not been central to financial policies. Thus, providers who aim for comprehensive, high-quality programs for patients facing serious and eventually fatal illness must work within complex reimbursement structures that do not fit patients’ needs well. In acute settings, long-term care settings, home health, physicians’ visits and hospice, the rules for Medicare reimbursements differ and are rapidly changing. Consequently, many providers do not know how to bill for appropriate care for a person who is very sick and expected to die. Many health-care provider organizations want to enhance services to seriously ill patients and their families by initiating organized palliative care programs. Often, organization leaders are unfamiliar with regulatory and reimbursement issues for palliative care, especially as patients cross programs. This article provides an overview of the reimbursement approaches for Medicare payments. This information gives a foundation for estimating a business plan, for discussions with fiscal intermediaries and with other area provider organizations, and for making financially viable strategic improvements in care for seriously ill patients.