Hospice documentation that protects your reimbursement 1 kinnser thanks annette lee, rn ms hcsd coss, for authoring this guide. 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. Please click on the accept and close button to affirm your consent and continue to use our website. Hospice documentation makes up the clinical record of a patient receiving hospice services. A report prepared for the bureau of hivaids, health resources and services administration. 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. Inpatient care refers to shortterm, general inpatient care. This may be provided either through a contract management with an appropriately licensed and medicare certified hospital, or a long term care facility, or directly by a hospice program in its inpatient facility. Recent investigations by the office of inspector general have shown a number of instances in which hospices inappropriately billed medicare for hospice general inpatient care gip. Does the documentation clearlyshow why there is a continued need for gip level of care.
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. Poor documentation can expose clinicians to disciplinary action and legal scrutiny. Gip for symptom management is a valuable tool that allows hospice staff to provide clinical services to a degree that cannot typically be provided in a patients home. The hospice general inpatient level of care criteria. Medicare reimburses the hospice gip level of care at a set rate. Accurate, compliant documentation needs to be standard practice for all clinicians but. A national study of nearly three thousand gip providers indicated that one third of all gip stays lasted longer than. They are a flexible framework for continuous quality improvement in hospice care and reflect current standards of practice. Patient record must support documentation in technical elements. The carolinas centers hospice facilities member interest group has developed this.
Utilize the audit tool to ensure regulatory compliance and a focus on improving the quality of care 3. The cops are the health and safety requirements that all hospices are required to meet. Nhpco provides its members with the essential tools they need to stay current with leading practices, understand policy changes, and. Mcns hospice policy and procedure manual provides over 400 readytoimplement policies, procedures and forms. The epub format uses ebook readers, which have several ease of reading features already built in. Hospice eligibility documentation tips and strategies. The hospice general inpatient level of care criteria, service guidelines, reimbursement and contracting. Today, i want to talk to you about hospice general inpatient care or g i p. Documentation of appetite appetite usually is a good indicator of decline in a hospice patient. Hospice care is the care provided to terminally ill patients who are not expected to live for more than six months. 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 general inpatient the hospice general inpatient information sheet dhs 6194 must.
This document provides a road map to implementing palliative care best practices. Medicare rules and regulations addressing hospice services require the documentation of sufficient clinical information and other documentation to support the certification of individuals as having a terminal illness with a life expectancy of 6 or fewer months, if the illness runs its normal course. 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. Avoid documentation of good, fair or poor appetite. Hospice coverage clinical documentation requirement for hospice coverage. Hospice quickflips cgs version and millions of other books are available for amazon kindle. Is there documentationthat treatments tried inthe home were ineffective. Does the plan of care reflect the interventions to be used to manage the. Additional references for the gip level of care for the medicare hospice benefit can be found within the hospice medicare claims processing manual section 30. Introduction general inpatient gip care is one of the four levels of hospice care required to be available under the medicare hospice benefit mhb. 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. Mln 006817 hospice payment system november 2019 508. 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.
All staff members need to be trained, oriented to hospice and their role in delivering care. At the time of the survey, the prospective hospice. 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. Palmetto gba gip video script hello, i am charles canaan. Understand the proposed content and administration of an audit tool created by the research advisory committee 2. Hospice documentation should always paint a clear picture of patient care throughout the benefit period. This book is simultaneously a teaching tool for new. The system maintainer is coding a correction, tentatively scheduled to be implemented on 4202020. This care must be provided in a medicare participating hospital, skilled nursing facility snf or hospice inpatient facility.
Hospice medical director billing guide aahpm connect. Incorporate the results of the audit tool as part of their quality improvement program 2. With the help of hospice, you can live the last days, weeks and even months of your life more fully utilizing the expertise of the hospice team and focusing on the things that matter most to you. As a result, these hospices were unable to provide gip patient referrals. Hospice agencies hospital contract status and differing levels of. Cms clarifies hospice coding and billing instructions. General inpatient gip level of care legacy hospice. Providing direct, billable physician services to hospice.
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. 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. Hospice billing and reimbursement essentials aapc knowledge. Resource guide for general inpatient gip level of care. This article dives deep into the topic of hospice orientation and training. 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. Improving your hospices compliance and documentation for general inpatient and continuous care th362 martina meier, md, providence trinitycare hospice. The documentation should always reflect working towards a lower level of care with discharge planning evident from the first day of the gip admission. This can be done in other settings, of course, so the hospice documentation must indicate why the gip level of care is necessary for the medication adjustment, i. Providing direct, billable physician services to hospice patients. Cms is looking for documentation that is complete, thorough, and patientspecific. If gip contracted, idt, including hospice physician.
Is the patient moving from an inpatient hospitalstay to a hospice facility. This video is intended to instruct hospice providers on what factors should be considered when determining an appropriate length of stay for a medicare beneficiary in hospice general inpatient. This website collects and uses cookies to ensure you have the best user experience. Avoid misconceptions and clarify guidelines to make endoflife services less intimidating. 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. Painting the picture in hospice documentation for eligibility. Medicare certified hospice is covered under the medicare hospice benefit. Great reference for eligibility under the medicare hospice benefit and cgs lcds documentation tips for nursing, therapies and social work pocket size easy to use for the following states.
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. Hospice payment system mln booklet learn about these medicare hospice benefit topics. Use of the guide should help those providing gip in any setting freestanding hospice facility, longterm care. She was thrown into being a hospice case manager and an admission nurse with no orientation as to why and what hospice nurses do. Nikki fuller, rn, legacy hospice corporate nursing director 012014. 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 policy and procedure manual mcn healthcare. A companion report will look at the appropriateness ofhospice general inpatient care provided to beneficiaries. An opportunity to upgrade the medical component of hospice care the hospice physician community 3 2 the supply, demand and use of palliative care physicians in the united states.
Characteristics of hospice patients utilizing hospice facilities ncbi. Hear expert advice on how to achieve the best documentation. This book is provided as a guideline but not a payment guarantee. Later as a director of patient care services, the same question was asked by almost every nurse that started to work hospice. The group produced this updated resource to be compliant with the current 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. We also provide the information necessary to succeed with the implementation of your program.
General inpatient care gip and continuous home care. Starting in january 2020, medicare systems stopped applying the eol sia payment on adjustments to hospice claims with eligible services that occurred the month prior and within 7 days of the beneficiarys date of death. Dont reinvent the wheel when developing policies and procedures. 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. Conversations between hospice and hospital gip staff this documentation should be made available to hospital gip staff. Terminal prognosis of 6 months or less lcd criteria days in any billing period without corresponding documentation showing eligibility are unpaid. The manual is crossreferenced to joint commission and achc standards and cms regulations, allowing you to stay current with the latest requirements. Browse the amazon editors picks for the best books of 2019, featuring our favorite reads in more. To be sure hospice services are reimbursed, you must follow guidelines found in the medicare claims processing manual, chapter 11. Gip days as the share of total medicare hospice care days.
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