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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 Services

Hospice is a very special kind of care and support service for anyone dealing with a life-limiting illness. MWHC Hospice has learned that the earlier hospice care begins the more meaningful and beneficial the support is for patients, caregivers and loved ones. We help people live comfortably, with dignity and manage patients’ pain and symptoms so they can more easily make decisions. We assist families in working through end-of-life logistics while grieving the illness and loss of a loved one. Preparations for the future are made with the patient so that their final days can be spent in peace with family and loved ones.

Our hospice team can admit a patient within 24 hours of a referral.

Who is Eligible?

Patients of all ages who have a prognosis of 6 months or less, if the disease follows its usual course; patients must forgo Medicare coverage for curative treatments related to terminal illness.

Primary Goals of Hospice Care

Improved quality of life and relief of suffering (physical, emotional and spiritual).

Interdisciplinary Team Approach

This team includes physicians, nurses, social workers, chaplains, expressive therapists and volunteers as dictated by statute.

Appropriateness for Hospice Services

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

Payment/Coverage

Medicare hospice benefit; standard hospice benefit from commercial payers is usually modeled after Medicare; Medicaid, although coverage varies by state; medication costs for illnesses related to the terminal illness.

Places of Care

Places of care include home (most common), assisted living facilities, nursing homes, residential hospice facilities, inpatient hospice units, or hospice-contracted inpatient beds. The overall intent is to allow the patient to stay at his/her place of residence.

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
  • Is a service rather than a geographical location, the patient must have a place of residence in order to receive hospice services.
  • Hospice provides intermittent RN, social work and bereavement support, with Certified Nursing Assistant (CNA), chaplain, therapy services, and volunteers as appropriate or requested.
  • Bereavement support is available for the family for 13 months after the patient’s death.
  • Patients may require different levels of care based on clinical needs, including respite, general inpatient (GIP) and continuous care.
  • Hospice RN is available 24/7 to respond to patients/family/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.

Download the Mary Washington Healthcare Hospice Services Provider Guide


Mary Washington Palliative Care Services

Palliative care specializes in the relief of the pain, dyspnea, or any symptoms and stress of people affected by serious, ultimately life-limiting illness – regardless of the diagnosis. The goal of palliative medicine is to improve quality of life for patients and their families. Palliative care is appropriate at any point in an illness and can be provided at the same time as curative treatment.

Who is Eligible?

Patients of all ages and with any diagnosis or stage of illness; patients may continue all lifeprolonging and disease-directed treatments. Palliative care is typically covered under the Medicare Part-B benefit and other commercial payers.

Primary Goals

Our goal is to improve quality of life for patients and their families.

Interdisciplinary Team Approach

Interdisciplinary team including physicians, nurses, social workers, chaplains and staff from other disciplines as needed.

Appropriateness for Palliative Care

No regulatory limitations on length of care. Palliative care is consulted to provide recommendations and support for patients with palliative needs identified during an acute care hospital stay or at the patient’s place of residence. The MWHC palliative team collaborates with the attending MD and other consulting specialists.

Places of Care

  • Inpatient Consultation Service - Inpatient palliative care is available at both Mary Washington and Stafford hospitals. The palliative care team helps support patients and families by partnering with the attending provider and/or specialists overseeing care in the inpatient setting.
  • Community Based Palliative Care (CbPC) - CbPC (sometimes referred to as Outpatient Palliative Care) is provided in a variety of settings, including assisted living facilities, nursing homes, specialized clinics, as well as patient homes. MWHC Palliative Services provides CbPC to any resident located in Planning District 16 and the immediate surrounding area.

How to Refer

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

Palliative Care Consult includes:

  • Patient/family needs help with complex decision-making and determination of goals of care
  • Complex pain and symptom management
  • Uncontrolled psychosocial or spiritual issues
  • Recurrent hospital admissions or multiple ED visits within past 30 days
  • Prolonged length of stay without evidence of improvement
  • Patient/family identified goals of care that are inconsistent with physician recommendations
  • Patient/family needs assistance with Advance Directives
  • Provider support is available 24/7 for consultation by phone

Palliative Consult examples:

  1. Family undecided about authorizing extubation, placement of artificial airways, or artificial nutrition for acutely ill patients.
  2. CAD or CHF at any stage with need for symptom management, goals of care discussions, or a transition to new level of care.
  3. Chronic lung disease with uncontrolled symptoms requiring multiple hospital or ED encounters.

Palliative care is appropriate at any point in an illness and can be provided at the same time as curative treatment.


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
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9271.pdf

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