Question: We have a potential pediatric private pay client referral coming to our agency. How do other agencies typically bill privately for Hospice, per diem or per visit?
Responses:
It can be done either way, however if you decide on per diem, you should be clear what that includes. For example, is the per diem payment just for Routine Home Care level of Care… the visits, meds supplies and DME. It would not include GIP, Respite or Continuous hours? What about any tests, labs, procedures? Would those items be included in the per diem payment? Sometimes per visit is easier.
Typically per diem. Per our admin director, when we have tried billing per visit, the per visit rate doesn’t account for all of the non-visit time the IDT spends coordinating care.
Yes most of the insurances i have worked with honor the medicaid hospice per diem- it is a bit different than adults as hospices cover only comfort med- not like prolonging medications like seizure meds, it does not cover life prolonging therapies such as Artificial nutrition and hydration. Their underlying insurance coverages continues that coverage. They do not have to give up extended hours nurses or any of their waivers. Please feel free to contact me if you have further questions Jody Chrastek
In my opinion, per diem is the best for the patient. If by ‘visit’ the patient/family may refuse the IDT visits due to cost and therefore accept only “nursing”, or only “________”.
Per Diem, for clarity sake compared to all your likely other patients which include your DME, Medical Supplies, etcetera at a per diem rate most commonly, it would be challenging albeit not impossible to do a per visit rate. I would confirm with BW that per visit adds a significant weight to how you individualize that contract prior to start of care. Transparency would be crucial. Pediatrics being separate from my experience, I would also be ensuring you have options and considerations for charity care/exploration of other means of billing, if an insurance/payor source is available it still must be billed and cannot be opted out of is my understanding.
