Medicare Hospice Room And Board: Surprise! We're Not Paying!

agitprop

New Member
My mother was admitted into hospice Thursday for terminal cancer after choosing not to use a bi-pap ventilator after getting a blot clot in her lung and possible pneumonia. Monday her blood pressure dropped and she fell unconscious and has not woken. Tuesday some nurse came in and said that starting Wednesday, based on a Medicare rule, she would be charged $350 room and board because her condition "changed". I don't recall how, but the words "acute management stage" and "routine level" were mentioned.

We told the nurse we were told by the hospital social worker she would be charged $350 a day if she took oral meds instead of IV; the hospice nurse said that was no longer the case.

The hospice is owned by the same hospital.

Does this rule sound accurate? If not, are there appeal options? Who makes the actual determination to charge my mother room and board and when? Someone at the hospital or some Medicare employee?
 
I am sorry to hear of your Mother's condition. My thoughts are with you. The following is from Medicare.gov.

"Room and board. Medicare doesn't cover room and board if you get hospice care in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay."

Reference: https://www.medicare.gov/coverage/hospice-and-respite-care.html
 

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