hospice & palliative care association of new york state · hospice & palliative care...
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Hospice
Hospice & Palliative Care Association of New
York State
Journey to the StarsHPCANYS 39th Annual Interdisciplinary Seminar & Meeting
April 2019
Hospice
Shelly Dailey MSN, BSN, RN, CPHM
Medicare Home Health and Hospice Clinical Consultant
Provider Outreach and Education
Today’s Presenters
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Hospice
Disclaimer
National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the CMS website at https://www.cms.gov.
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Hospice
No Recording
Attendees/providers are never permitted to
record (tape record or any other method) our
educational events
This applies to our webinars, teleconferences, live events
and any other type of National Government Services
educational events
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Hospice
Objectives
To assist providers with a greater
understanding of the federal Medicare
hospice benefit regulations regarding
medical record documentation that will
support terminal prognosis.
Ensure a comprehensive understanding of the
documentation requirements for the four levels
of hospice care
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Hospice
Agenda
Medicare Hospice Coverage
Beneficiary Election Statement
Physician Certification of Terminal Illness (PCTI)
Hospice Nursing Documentation
Levels of Care
Routine Home Care (RHC)
Continuous Home Care (CHC)
Inpatient Respite Care (IRC)
General Inpatient Care (GIP)
Documentation Collaboration
Example/Scenario
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Hospice
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Hospice
Hospice Coverage
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CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
Chapter 9, Section 10, “Requirements- General”
Hospice
Hospice Beneficiary Election Statement
Each hospice designs and
prints its own election
statement.
Ensure that the form is
completed correctly and
appropriately signed and
dated by the bene or the
beneficiaries
representative.
Includes seven elements:
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Hospice
Hospice Beneficiary Election Statement
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Identify Agency
Palliative/Comfort Care
Waived Services
Effective Date
Attending Physician
Beneficiary Choice
Signature
Hospice
Physician Certification of Terminal Illness
Must be provided by a
physician no later than two
calendar days after
hospice care is initiated or
by the end of the third day.
If the agency cannot obtain
a written certification, it
must obtain an oral
certification within that
same time frame.
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Hospice
Oral Physician Certification ofTerminal Illness
Documentation within the medical record needs to include Statement that the patient will be admitted into hospice care
(suggested)
Hospice diagnosis (suggested)
A statement that the patient is terminally ill with a prognosis of six months or less
Entry authentication
• Hospice staff signs and dates their entry for documenting the oral certification
• Physicians providing the oral certification are not required to sign an oral certification
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Hospice
What is a Nurse
The American Nursing Association defines
nursing as
“…the protection, promotion, and optimization of health
and abilities, prevention of illness and injury, facilitation of
healing, alleviation of suffering through the diagnosis and
treatment of human response, and advocacy in the care of
individuals, families, groups, communities, and
populations.”
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Hospice
Typical Nursing Documentation
Focus on identification of
issues, creation of care plans
based on findings and
implementation of
interventions and treatment
plans in an effort to optimize
health and achieve goals.
If the patient fails to achieve
goals: re-evaluate and revise
the treatment plan.
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Hospice
Hospice Nursing Documentation
Focus on patient deterioration and decline
Good objective data
Must support PCTI that the patient has a life expectancy <6 months
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Hospice
CustodialComfort/Palliative/Terminal Care
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Hospice
Comfort Care
The care that is delivered to a dying patient in an effort to provide symptom relief while the patient continues to show signs and symptoms of deterioration and disease progression that provide evidence that he or she will not live longer than six months.
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Hospice
Hospice Nursing Documentation
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Hospice
Hospice Nursing Documentation
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Hospice
Hospice Nursing Documentation
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Hospice
Hospice Nursing Documentation
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Hospice
Hospice Nursing Documentation
Cachectic
Anorexic
Non-Ambulatory
Dyspneic
Weight Loss
Poor Appetite
Fragile
Failing
Weaker
As evidenced by…..
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Hospice
Hospice Nursing Documentation
Specific
Objective
Measureable
Support the trajectory of decline related to the terminal diagnosis
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Hospice
Hospice Plan of Care
Established prior to services
being rendered
Must be reviewed as frequently
as the patient’s condition
requires and no less frequently
than every 15 calendar days
Document interventions and
patient response
All services performed must be
consistent with the POC
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Hospice
Hospice Levels of Care
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Hospice
Routine Home Care (RHC)
Majority of hospice claims billed
at RHC
Paid without regard to volume or
intensity
Paid for each day patient is
under the care of the hospice
and not receiving one of the
other categories of hospice care
Must be documentation to
support terminal prognosis
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Hospice
Routine Home Care (RHC)
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• Include clinical findings,
interventions, patient
response.
• Support terminal illness
with weight, VS, arm
circumference, wound
measurements, etc.
• Describe patient
decline/deterioration.
Hospice
Continuous Home Care (CHC)
Continuous home care may be provided only during a period of crisis.
A period of crisis is a period in which a patient requires continuous care that is primarily nursing care to achieve palliation or management of acute medical symptoms.
CHC is not intended to be used as respite care.
Hospice
Continuous Home Care (CHC)
• Must provide a minimum of 8
hours of care during a 24-hour
day; beginning and ending at
midnight.
• Care does not need to be
continuous (example: four
hours in morning, four hours in
evening).
• Must be predominately nursing
care provided by either an RN,
an LPN, or an LVN.
Hospice
Continuous Home Care (CHC)
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Support
a Crisis
Situation
Hospice
Inpatient Respite Care (IRC)
Hospice
Inpatient Respite Care (IRC)
CR8569 implements system edits to prevent payment of respite care for more than five days for all claims submitted on or after 7/1/2014
IRC cannot be reimbursed for more than five consecutive days at a time
Every day of IRP beyond fifth consecutive day
billed and paid at the routine home care rate (0651)
claims reporting respite periods > five consecutive days will RTP
Hospice
Inpatient Respite Care (IRC)
More than one IRC episode in a billing period hospice agency must
utilize Occurrence Span Code M2
Hospice
General Inpatient Care (GIP)
General inpatient care is an integral component of a
comprehensive hospice program because patients who elect
the Medicare Hospice Benefit no longer have Medicare Part
A benefits to cover acute-care hospitalization.
Therefore, the Medicare Hospice Benefit requires that all
hospices provide patients access to general inpatient care
for the management of pain and other symptoms.
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Hospice
General Inpatient Care (GIP)
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• GIP is provided only when the beneficiary requires an intensity of care
directed towards pain control and/or symptom management that cannot be
managed in any other setting.
• Documentation must support the crisis and include the interventions that are
being performed that could not feasibly be performed in any other setting.
• Example: Pain Crisis - monitored, assessed and treated with changes in
medication regimen. Documentation should reflect every aspect of the
medication adjustments, interventions and stabilization treatments.
Hospice
General Inpatient Care (GIP)
Symptoms and/or Pain
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0 2 4 6
Tuesday
Wednesday
Thursday
Friday
Increased Level of Intensity of Service Related to
Increased Uncontrollable Symptoms/Pain
• Sudden deterioration or
increasing pain requiring intensive
nursing intervention
• Uncontrolled nausea and vomiting
• Unmanageable respiratory
distress
• Open lesions requiring frequent
skilled care
• Pathologic fractures
• Complex traction/repositioning
• Complex wound care
• Severe agitated delirium, acute
anxiety or depression secondary
to the end-stage disease process
requiring extensive intervention
• Imminent death
Hospice
General Inpatient Care (GIP)
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Hospice
Documentation Collaboration
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Hospice
Scenario
72 Year Old Female Patient
Diagnosis: Alzheimer’s Disease
Hospitalized 6.20.2016 for Pneumonia
Hospital Admission Weight = 85#
Discharged from Hospital and Returned
Home with Primary Care Giver (Daughter)
on 6.25.2016
Hospice Admission Weight = 82.5#
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Hospice
Scenario
Claim DOS: 10/1/2016–10/30/2016
Documentation includes that the patient
Has poor appetite
Appears thin, clothes are loose fitting
Totally dependent for all ADLs
Incontinent of urine and feces
Non-verbal
Oxygen increased
Sleeps most of the time
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Hospice
Scenario
CLAIM DOS: 10/1/2016–10/30/2016
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Comorbidities include CHF, diabetes, ischemic
heart disease
02@4LNC increased from previous 2LNC
yesterday
Has poor appetite- eating 3 to 4 bites of food
with difficulty, last week was eating 2 full
meals per day
Drinks 2-3 sips of thickened liquids and
aspirates easily, last week was drinking 2
glasses per day
Family reports patient sleeps 19 of 24 hours,
last week awake 10 to 12 hrs/day
Totally dependent for all ADLs, patient no
longer assisting with care
Hospitalized 06/20/2016 for pneumonia
Oxygen saturation
• 08/19/16 92% on 2L per N/C
• 08/20/16 88% on 4L per N/C
Blood sugars family reports
• 08/15/2016 AM blood sugar 62
• 08/15/2016 HS blood sugar 386
Weights
• 06/20/2016- 85.0 LBS
• 06/25/2016- 82.5 LBS
• 07/20/2016- 82.0 LBS
• 08/15/2016- Patient refused wt
• 10/02/2016-81.0 LBS
Hospice
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Hospice
Hospice Resources
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Hospice
National Government Services WebsiteHospice Resources
https://www.NGSMedicare.com
Log in or enter as a guest
Select I am a…HH+H for the Home Health and Hospice Portal
Select the state in which you bill
Hospice Job AidsClick the Education Mega Tab, then click the Job Aids & Manuals link on the right-hand side
Hospice Policy ArticlesClick the Medical Policy & Review Mega Tab, then click the Policy Education Topics link on the left-hand side
Hospice Payment RatesClick the Claims & Appeals Mega Tab, then click the Fee Schedules and Pricers link on the left-hand side
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Hospice
CMS Hospice Resources
CMS website, Hospice Center
CMS website, Transmittals
CMS website, Internet-Only Manuals
Medicare Benefit Policy Manual (Publication 100-02)
• Chapter 9 (Hospice Coverage)
Medicare Claims Processing Manual (Publication 100-04)
• Chapter 11 (Hospice Billing)
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Hospice
Email Updates Subscribe to receive the latest Medicare information.
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Hospice
Website and Portal Satisfaction –We Value Your Feedback
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Hospice
Medicare University
Interactive online system available 24/7
Educational opportunities available
Computer-based training courses
Teleconferences, webinars, live seminars/face-to-face
training
Self-report attendance
Website
https://www.MedicareUniversity.com
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Hospice
Medicare University Self-Reporting Instructions
Log on to National Government Services’
Medicare University https://www.MedicareUniversity.com
• Topic = Hospice: HPCANY Journey to the Stars 2109
• Medicare University Credits (MUCs) = 1
• Catalog Number = AA-C-04707
• Course Code = 19091SASRD1
• Visit our website for step-by-step self-reporting instructions.
• Click on the Education tab, then the Medicare University Course List tab,
click on the Get Credit link. This will open the Get Credit for Completed
Courses web page.
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Hospice
Continuing Education Credits
All National Government Services Part A and Part B
Provider Outreach and Education attendees can
now receive one CEU from AAPC for every hour of
National Government Services education received.
If you are accredited with a professional
organization other than AAPC, and you plan to
request continuing education credit, please contact
your organization not National Government
Services with your questions concerning CEUs.
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Hospice
Contact Us
For future hospice questions or issues
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Email: [email protected]/Region Toll-Free Number IVR PCC Hours of Service
Alaska, Arizona, California,
Hawaii, Idaho, Nevada,
Oregon, Washington,
American Samoa, Guam,
Northern Mariana Island
866-590-6724
TTY: 888-897-7523
866-277-7287 Monday–Friday,
8:00 a.m.–4:00 p.m. PT
Thursday, closed for training
12:00–2:00 p.m. PT
Connecticut, Maine,
Massachusetts, New
Hampshire, Rhode Island,
Vermont
866-289-0423
TTY: 866-786-7155
866-275-7396 Monday–Friday,
8:00 a.m.–4:00 p.m. ET
Thursday, closed for training
2:00–4:00 p.m. ET
Michigan, Minnesota, New
York, New Jersey, Wisconsin,
Puerto Rico, U.S. Virgin
Islands
866-590-6728
TTY: 888-897-7523
866-275-3033 Monday–Friday,
8:00 a.m.–5:00 p.m. CT
9:00 a.m.–6:00 p.m. ET
Thursday, closed for training
2:00–4:00 p.m. CT
3:00–5:00 p.m. ET
Hospice
Thank You!
Questions?
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