Accurate, compliant documentation needs to be standard practice for all clinicians but sometimes thats easier said than done. What do you see painting the picture in hospice documentation for eligibility. Medicare conditions of participation and offers it to hospice agencies as a guide for utilization, coordination and documentation of the general inpatient gip level of care. Find out more about the history of hospice, where to find a hospice in your community, and what to expect when receiving hospice care. Hospice quickflips can be used as a reference for documentation, hospice eligibility, including lcds, idt basics including the physician role, his, criteria for respite, gip and continuous care. Hospice quickflips cgs version and millions of other books are available for amazon kindle.
Pearls for practice is a bundle of sessions that were recorded live at the 2017 annual assembly. Mln 006817 hospice payment system november 2019 508. What do you see painting the picture in hospice documentation. Is the patient moving from an inpatient hospitalstay to a hospice facility. The hospice bundle contains the following sessions in mp3 format. Incorporate the results of the audit tool as part of their quality improvement program 2. Is it ok for hospices to have hhas provide home care services unrelated to a hospice patients terminal illness. She was thrown into being a hospice case manager and an admission nurse with no orientation as to why and what hospice nurses do. Hospice documentation for the idt missouri hospice and discuss strategies for improving documentation quality of the medicare investigated this hospice for two years, focusing on. Hospice coverage clinical documentation requirement for hospice coverage. Documenting to dazzle missouri hospice and palliative. Use of the guide should help those providing gip in any setting freestanding hospice facility, longterm care facility, or hospital to define their own policies and processes.
Palmetto gba gip video script hello, i am charles canaan. Gip documentation office of the inspector general oig reports that more than onethird of hospice gip stays lack the following information. At this stage, the focus is on providing physical, emotional and spiritual support to the patient instead of concentrating on finding a cure for his illness. Nhpco provides its members with the essential tools they need to stay current with leading practices, understand policy changes, and improve their quality of care. Hospice election statements did not include that the beneficiary was waiving coverage of certain medicare services by electing hospice care or that hospice care is palliative rather than curative. Documentation of appetite appetite usually is a good indicator of decline in a hospice patient. The goal of the hospice care team is to help the patient achieve a full life as possible, with minimal pain, discomfort, and restriction.
Lcds, idt basics including the physician role, his, criteria for respite, gip and. Annette lee is a hospice and home care, home health regulatory specialist and one of the foremost educators on effective documentation strategies and medicare reimbursement. Medicare certified hospice is covered under the medicare hospice benefit. View and download powerpoint presentations on hospice nurse documentation ppt. Hospice payment system mln booklet an individual or representative may revoke the election of hospice care at any time. Terminal prognosis of 6 months or less lcd criteria days in any billing period without corresponding documentation showing eligibility are unpaid. Hospice maintains professional management of the patient documentation by hospice staff should reflect that management should illustrate the coordination of care between the hospice and the contracted facility providing gip level of care on discharge need either a discharge summary or. Hospice quickflips can be used as a reference for documentation, hospice. Improving your hospices compliance and documentation for general inpatient and continuous care how to address clinical and regulatory issues for eligible hospice patients living past their expected. Industry best practice also states that hospice providers are obtaining a physicians order to change the level of care. Instead give the number of meals that the patient ate per day along with the % of intake of each meal. This resource can be a teaching tool for new employees and hospice managers. This document provides a road map to implementing palliative care best practices.
She earned her masters degree in nursing education from california state university fresno. This book is provided as a guideline but not a payment guarantee. Does the plan of care reflect the interventions to be used to manage the. Hospice policy and procedure manual mcn healthcare. Chamberlain, md facp faahpm medical director palliative care service. Patient record must support documentation in technical elements. If a physician has an agreement with a hospice agency to provide medical care and services to hospice patients then medicare regards them as a. While most hospice programs are admitting eligible patients, they often dont prove eligibility with their documentation.
Palmetto gba gip video script hello, i am charles canaan, senior provider education consultant at palmetto gba. Utilize the audit tool to ensure regulatory compliance and a focus on improving the quality of care 3. Dont reinvent the wheel when developing policies and procedures. Today, i want to talk to you about hospice general inpatient care or g i p. The hps alliance is a membershipbased home care and hospice educational resource. The manual is crossreferenced to joint commission and achc standards and cms regulations, allowing you to stay current with the latest requirements. Find all the books, read about the author, and more. Once the patient is admitted to gip the hospice team must document each day the continued need for the gip level of care that identifies the specific symptoms being managed. Avoid documentation of good, fair or poor appetite. Hospice documentation should always paint a clear picture of patient care throughout the benefit period. The cops are the health and safety requirements that all hospices are required to meet. Saul ebema the singlemostscrutinized area for hospice providers by the u. There are several types of physicianhospicepatient relationships.
The hospice general inpatient level of care criteria, service guidelines, reimbursement and contracting. This care must be provided in a medicare participating hospital, skilled nursing facility snf or hospice inpatient facility. Hospice care is an elected benefit covered under medicare part a for a patient who meets all. The documentation should always reflect working towards a lower level of care with discharge planning evident from the first day of the gip admission.
Find powerpoint presentations and slides using the power of, find free presentations research about hospice nurse documentation ppt. Accurate, compliant documentation needs to be standard practice for all clinicians but. It is not intended to define rigid criteria for the. Find the top 100 most popular items in amazon books best sellers. The carolinas centers hospice facilities member interest group has developed this resource, and continually updated it, to guide hospice agencies in the utilization, coordination and documentation of the general inpatient gip level of care in accordance with the medicare conditions of participation cops. Jan, 2016 dementia hospice medicare requirements 2020 election of hospice medicare benefit form 2019 disenrollment from medicaid managed care new york hospice 2019 hospice conditions of participation 2016 hospice certification date calculator documentation for gip in hospice discharge status 50 or 51 for hospice cms hospice calculator for. Hospice contracting checklist for inpatient services, respite care and vendor agreements the following checklist can be used to verify that the regulatory requirements are addressed in hospice contracts for inpatient services, respite care, and vendor. Hospice payment system mln booklet learn about these medicare hospice benefit topics. Is the certification statement signed and dated by the hospice medical director or a hospice physician member of the idg no later than 2 calendar days after. Mcns hospice policy and procedure manual provides over 400 readytoimplement policies, procedures and forms. Clinical documentation and audits the clinician connection ask the experts march 2012 roseanne berry, msn, rn consultanteducator what you will learn the purpose of.
Jun 05, 2008 the cops are the health and safety requirements that all hospices are required to meet. Identify the regulatory requirements for general inpatient level of care 2. General inpatient gip must occur in contracted ltc or hospital for symptoms that cannot be managed in the home setting. When it comes to length of stay, medicare policy does not specify the number of days gip is allowed, although it is intended to be shortterm.
Painting the picture in hospice documentation for eligibility. Aug 26, 2009 a recent whistleblower lawsuit highlights gips status as a hospice hot spot. Great reference for eligibility under the medicare hospice benefit and cgs lcds documentation tips for nursing, therapies and. Getting it right august 2016 subscriber webinar the plan for this session 1. Hospice documentation that protects your reimbursement 1 kinnser thanks annette lee, rn ms hcsd coss, for authoring this guide. Hospice care provides comprehensive physical, psychological, social, and spiritual care for terminally ill patients. Browse the amazon editors picks for the best books of 2019, featuring our favorite reads in more. Hospice clinical documentation hospice benefit available to.
Levels of hospice care routine carecan occur anywhere respite care for caregiver reliefmaximum of 5 day period. Hospice is a medicare part a benefit most often provided to an overview of the guidelines and clarification of several misconceptions will help you with claims payment for hospice services. Cms clarifies hospice coding and billing instructions. Is there documentationthat treatments tried inthe home were ineffective. Clinical documentation and audits the clinician connection ask the experts march 2012 roseanne berry, msn, rn consultanteducator what you will learn the purpose of documentation the role of the clinician in documentation. Hospice care is the care provided to terminally ill patients who are not expected to live for more than six months. The generous contributions of two other individuals. Summary hospice general inpatient care gip is for pain control or symptom management. A companion report will look at the appropriateness ofhospice general inpatient care provided to beneficiaries. Later as a director of patient care services, the same question was asked by almost every nurse that started to work hospice.
Hospice billing and reimbursement essentials aapc knowledge. Hospice medical director billing guide aahpm connect. Describe patients who are eligible for and can benefit from higher level of care 3. Avoid misconceptions and clarify guidelines to make endoflife services less intimidating. A national study of nearly three thousand gip providers indicated that one third of all gip stays lasted longer than. Most hospice programs serve terminally ill patients from the comforts and relaxed surroundings of their own home, although there are some located in inpatient settings. From admission, to clinician visits, to recertification, nurses, social workers, and chaplains must document. Documentation of the skilled need or problem necessitating ipu admission documentation that, together, the caregiver and the hospice cannot provide the necessary care plan in the patients home gip following a hospital stay must include documentation why the care cannot be provided in the home at the time of hospital discharge. If gip contracted, idt, including hospice physician.
The hospice general inpatient level of care criteria, service. As a medicare contractor for cms, palmetto gba is tasked with preventing claims payment errors. With resources that address the challenges providers navigate on a daily basis, nhpco offers a wealth of expert kn. Does the documentation clearlyshow why there is a continued need for gip level of care. Poor documentation can expose clinicians to disciplinary action and legal scrutiny. The family handbook of hospice care would continue to be a loose collection of miscellaneous booklets and photocopied handouts if marne oberg and lyndsay hall of fairview public relations had not recognized its potential and called fairview press to explore the feasibility of writing a book. They are a flexible framework for continuous quality improvement in hospice care and reflect current standards of practice. Resource guide for general inpatient gip level of care. Cms clarifies hospice coding and billing instructions aapc. Review gip documentation details on the reasons for the change in level of care documentation daily physician or np visit documented and billed daily documentation is consistent regardless of location of gip. Use of the guide should help those providing gip in any setting freestanding hospice facility, longterm care. The hospice must document the circumstance to support a request for an exception, which would waive the consequences of filing the noe late.
Continuous care for symptoms requiring extensive intervention. Understand the proposed content and administration of an audit tool created by the research advisory committee 2. It is the individuals or representatives choice to revoke the election of hospice care without undue influence from you. Nhpco provides its members with the essential tools they need to stay current with leading practices, understand policy changes, and. This final rule updates the hospice wage index, payment rates, and cap amount for fiscal year 2020. General inpatient care gip is available to all hospice beneficiaries who are in need of pain control or symptom management that cannot be provided in any other setting. Regulatory explore the many tools and resources that help you understand and comply with state and federal regulations, all delivered in plain english. Healthcare provider solutions is dedicated to providing our clients with industry leading education in order to keep you informed, educated, and performing at the highest level of success. The hospice general inpatient level of care criteria. If the hospice and the caregiver, working together, ar e no. General inpatient care gip and continuous home care. The carolinas centers hospice facilities member interest group has developed this. This rule also rebases the continuous home care, general inpatient care, and the inpatient respite care per diem payment rates in a budgetneutral manner to more accurately align medicare payments.