Hospice

If the social worker meets with the primary caregiver to provide support in a different location than the pt's home setting should the visits count on the hospice claim even though the patient is not present? For example, the patient resides in a SNF, and the spouse doesn't drive and has a difficult time coming to the facility. Spouse desires in-person visits with the SW for support and requested that these visits occur in their home rather than the SNF. 

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Sandy Nelson, MSN, RN, CHPN
Regulatory Compliance Specialist
Corewell Health Hospice and Palliative Care
Grand Rapids, MI
sandra.nelson@corewellhealth.org
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Based on CMS manual instruction, I believe the SW visit with a family member at a location other than that where the patient is located could be entered on the claim. Per the Medicare Claims Processing Manual, Chapter 11, a visit is:

To constitute a visit, the discipline, (as defined above) must have provided care to the beneficiary.
Services provided by a social worker to the beneficiary's family also constitute a visit.

The location of the visit for a social worker is not prescribed as having to be with the beneficiary. There may be state or hospice policy requirements that are more strict than the Medicare coverage and billing requirements. 

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Katie Wehri
Vice President of Regulatory Affairs, Quality & Compliance
National Alliance for Care at Home
Washington DC
+1 (202) 547-7424
kwehri@allianceforcareathome.org
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