April 2016 Subscriber Webinar - Hospice …

1 Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved1 The Certification/ Recertification Process: No Room for ErrorApril 2016 Subscriber Webinar What You Will Learn Today Regulatory requirements Election of the Medicare Hospice Benefit Certification RecertificationOperational issues surrounding the certification process and guidanceNote: Specific to Medicare Hospice BenefitIf your state has additional requirements, you must follow the stricter requirementSubpart F Covered Services To be covered, Hospice services must meet the following requirements.

2 1. They must be reasonable and necessary for the palliation or management of the terminal illness as well as related conditions. 2. The individual must elect Hospice care in accordance with Sec. 3. A plan of care must be established and periodically reviewed by the attending physician, the medical director, and the interdisciplinary group of the Hospice program as set forth in Sec. 4. The plan of care must be established before Hospice care is provided. 5. The services provided must be consistent with the plan of care. 6. A certification that the individuals terminally ill must be completed as set forth in Sec.

3 Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved2 Why Do We Care? The Hospice Medicare benefit is for those who are terminally ill and want Hospice careMedicare payment requirement Must have a valid election statement Must have a written certification and narrative statement before you submit a claim for payment Must have completed a face to face encounter and attestation prior to 3rdand subsequent benefit periods All must be completed according to very specific time framesAllows for billing for all days of serviceIncreasing Scrutiny by CMS DirectorInitial of Terminal IllnessNarrative of Terminal IllnessFace to

4 Of Hospice CareIdentification of attending on EOBThe Sum of the Parts = The WholeTechnical Payment Requirements MetElectionCertificationNarrativeFace to Face (3rd+) Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved3 Election of Hospice Care Issues and What the Regulations Really SayPurpose of the Election To provide the beneficiary with information about electing the Medicare Hospice Benefit To determine the date the Medicare Hospice Benefit becomes effective To identify the attending physicianPalliative Versus Curative & Waived ServicesThe Issue Election form does not address Hospice care is palliative not curative Election form does not explain waiver of certain Medicare

5 ServicesThe Rules Election form includes acknowledgement that individual has been given full understanding of palliative rather than curative nature of Hospice services Election form includes acknowledgement of waiver of certain Medicare Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved4 Beneficiary SignaturesThe IssueHaving someone besides the beneficiary sign when beneficiary has decision making capacity The RuleIt is the beneficiary s right to elect the benefit and to understand the consequences of the electionEffective Date of ElectionThe IssueBackdating an election effective dateThe RuleThe effective date may be no earlier than the date the election was signed The IssueThe far away POA gives a verbal electionThe RulesThere is no allowance for a verbal election of the benefitEffective Date of ElectionThe Issues Beneficiary in hospital elects date and then hospital discharge is delayed Changing the election date or leaving blank for Hospice to complete The RulesIt is the beneficiary s right to determine the effective date.

6 This cannot be determined by the Hospice . Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved5 Attending PhysicianThe IssueAttending physician not identified and acknowledged on election of benefit formAttending physician filled in later by the hospiceThe RulesElection statement must contain identification of attending physician that will provide care to the individualIndividual or representative must acknowledge that the identified physician was his or her choiceNurse practitioner can be chosen as attending physicianAttending PhysicianThe IssueIndividual does

7 Not have an attending physician or the identified attending physician refuses to RulesCMS notes several times that that if the attending physician cannot provide needed physician services, then the Hospice physician or Hospice NP is required by the Hospice CoPs to meet the medical needs of the beneficiary. Time of Election: Who s the Attending? Identified potential attendingsaysHospiceActionI m ready and willing Get CTI and move forward Keep me posted but I d like Hospice physicians to follow her Informbeneficiary / repOffer hospicephysician or NPI do not wish to servein this roleAsk ifother choiceOffer Hospice physician or NP I wantto see him first.

8 Have him come in to the office next week. Decision to make does beneficiary need care now or canhe wait until after visit? SilenceHospicephysician or NPOther community doc as identified by the beneficiary I m a hospitalist CMS says that they do not prohibit this choice but suggest thatthe Hospice explain the limitations Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved6 Certification of Terminal Illness Issues and What the Regulations Really SayPurpose of the CertificationStatutory requirementPhysician prognostications of 6 month life expectancy - Certification of Terminal Illness Admission to Hospice Care Medical

9 DirectorRegulations Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved7 Timing of CertificationThe IssueNot obtaining certification within the appropriate time frameThe Rules If the Hospice cannot obtain the written certification within 2 calendar days after a period begins, it must obtain an oral certification within 2 calendar days and the written certification before it submits a claim for and recertifications can be completed no more than 15 days prior to the start of the benefit FormThe Issues Benefit periods ( from and to dates) not on certification form Signatures not dated by the physicianThe Rule The written certifications and recertifications must include the signature(s) of the physician(s)

10 , the date signed, and the benefit period dates that the certification or recertification of Attending in Certification The Issue Not obtaining a certification from the attending physicianThe Rules For the initial 90 day period, the Hospice must obtain written certification statements (and oral certification statements if applicable) from The medical director or the physician member of the Hospice interdisciplinary group (IDG); and The individual's attending physician, if any. For subsequent periods, the only requirement is certification by the Hospice medical director or physician member of the Fundamentals Subscriber WebinarApril 2016 2016 Hospice FundamentalsAll Rights Reserved8 Who Provides the Certification?