By the Bay Health

Hospice Care

HOSPICE ELIGIBILITY

We care for nearly 3,000 patients annually who have terminal diagnoses, including cancer, heart disease, ALS, pulmonary disease, stroke, liver disease, and dementia, with a prognosis of six months or less.

Download the Hospice Diagnosis Eligibility Guidelines for health professionals, including Local Coverage Determinations (LCDs) and other staging tools, to help determine a prognosis of six months or less. We invite you to contact our team of Hospice Physicians with any questions about a patient’s eligibility or about hospice care, at (888) 720.2111, day or night.

LEVELS OF CARE

Our goal is to provide patients with the level of care that best suits their needs for symptom management, taking into consideration the needs of their caregivers, as well. Our mission is care for patients wherever they call home. For a consultation with one of our Hospice Physicians, please call (888) 720.2111.

Routine Home Care

  • Hospice services are provided by care team members, who make regular visits wherever the patient calls home – a family residence, a long-term care facility, RCFE, etc.
  • The care team includes a Hospice Physician, a primary nurse, social worker, home health aides, spiritual support counselor, and a trained volunteer
  • The team collaborates with the patient’s own physician, family members, and caregivers to see that patient’s choices about care are respected and comfort and quality of life is maximized
  • Nurses on call 24/7 to answer questions or make emergency visits

Respite Care

  • Short-term in-patient care is provided to the patient only to relieve family members or others caring for the individual at home.
  • Respite is provided only on an occasional basis. Only five consecutive days at a time are reimbursed
  • Care must be provided in a Medicare or Medi-Cal in-patient facility that is contracted with By the Bay Health to provide respite care to hospice patients

General In-patient Care (GIP)

  • Short-term care in a Medicare-certified hospital or long-term care facility to provide symptom management that cannot be accomplished in another setting.
  • Ordered for issues such as: uncontrolled pain, dyspnea, nausea and vomiting, seizures, hemorrhaging, or agitation
  • The need for GIP is evaluated throughout the crisis. Once the symptoms are resolved, the care team is responsible for planning for discharge
  • The By the Bay Health team collaborates with the in-patient facility on the patient’s plan of care

Continuous Care

  • Provided during a crisis when a patient requires primarily nursing care to achieve palliation or management of acute medical symptoms.
  • Examples include: uncontrolled pain, dyspnea, nausea or vomiting, seizures, hemorrhaging, or agitation
  • Care is provided in the patient’s place of residence for a minimum of eight hours of care (at least half must be nursing care)
  • The need for Continuous Care is evaluated throughout the crisis and is discontinued once the crisis is resolved

REIMBURSEMENT

Physicians who refer patients to By the Bay Health remain involved in their patients’ care and can continue to be reimbursed for their services.

Attending Physician

As a referring physician, most patients will select you as Attending Physician for hospice care. An attending physician is part of our hospice team coordinating the patient’s care. You bill and receive reimbursement from Medicare directly for ALL services provided, whether or not they are related to the patient’s terminal diagnosis. Services related to the terminal diagnosis simply require the use of modifier code “GV” on claims. Unrelated services require the code “GW.”

Consulting Physician

A physician NOT named Attending Physician for hospice care becomes a Consulting Physician and remains involved in the patient’s care. With pre-authorization, services related to the terminal diagnosis are reimbursed directly from By the Bay Health. Unrelated services are billed directly to Medicare using the modifier code “GW.”

BILLING

Call our Finance Department, (415) 927.2273, for direction and support for physician billing for By the Bay Health patients.