Medical benefit policy manual, chapter 9, coverage of hospice services. The gip scatter bed program was built upon a contract between the hospital and the hospice that allowed the hospice to contract for beds and services. For example, a hospice billed for gip for a beneficiary with a circulatory disease who had no unmanaged symptoms. Medicare certified hospice is covered under the medicare hospice benefit. Hospice agencies hospital contract status and differing. The care is intended to be short term and is not intended to be custodial or residential. This manual addresses core concepts and topics known to assist you in your work within hospice and palliative care, especially within a rural setting. Admission to the hospice house is based on physician approval, acuityneed and available space.
Currently, she is the hospice medical director for scripps hospice in san diego, california. Hospice b waits until day five july 9, 2018 to file their noe, hoping hospice as noe clears before theirs. Hospice care is the care provided to terminally ill patients who are not expected to live for more than six months. The oig recommends that cms increase its oversight of gip claims and follow up on inappropriate gip stays. Some states, such as florida, had many inappropriate gip stays. Suggestions for improved documentation to support medicare. Avoid documentation of good, fair or poor appetite.
Find out more about the history of hospice, where to find a hospice in your community, and what to expect when receiving hospice care. The information in this booklet and support from a doctor and trained hospice care team can help you choose the most appropriate health care options for someone whos terminally ill. Cms fy2020 hospice payment rule rebases rhc, gip and. 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. About 4 in 10 hospice patients were in the hospital before hospice enrollment. Joanne nowak, md, medical director, partners hospice members. Improving your hospices compliance and documentation for general inpatient and. Mln 006817 hospice payment system november 2019 508.
General inpatient level of hospice careyou, too, can gip. Define general inpatient gip level of care criteria. It is not intended to define rigid criteria for the. The hospice general inpatient level of care criteria. 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. 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. 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. General inpatient gip level of care legacy hospice. Is it ok for hospices to have hhas provide home care services unrelated to a hospice patients terminal illness.
The hps alliance is a membershipbased home care and hospice educational resource. If gip contracted, idt, including hospice physician. 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 b has the same rules for filing noe as hospice a. 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 admission guidelines welcome hospice heart. With resources that address the challenges providers navigate on a daily basis, nhpco offers a wealth of expert kn. For those hospices that have their own inpatient facility and want to fill it, the criteria are sometimes a little easier to come by.
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. The community hospice alexander cohen hospice house is essentially a hospice hospital and it is intended for short. This section contains instructions for completing the hospice general inpatient information sheet, which is used to transfer a medical hospice patient to a general inpatient level of care. I have found the gip criteria to be a bit variable based on the hospice. Does the plan of care reflect the interventions to be used to manage the. This resource can be a teaching tool for new employees and hospice managers. Hospice house provides 16 private inpatient rooms and 24hour care in a comfortable homelike setting. General inpatient care gip may only be provided in a medicare.
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. Hospice eligibility documentation tips and strategies hospice. Summary hospice general inpatient care gip is for pain control or symptom management. 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. Care coordination takes place with staff in hospitals or snf toward poc goals of comfort, symptom management or toward successful discharge planning.
Just the act of fraudulently placing patients in higher care categories costs medicare hundreds of millions of dollars each year. Gip documentation office of the inspector general oig reports that more than onethird of hospice gip stays lack the following information. 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. It is intended as a guide to direct you to other resources that will supplement the information provided. 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.
Understand the proposed content and administration of an audit tool created by the research advisory committee 2. What we will discuss today painting a picture of eligibility. Describe patients who are eligible for and can benefit from higher level of care 3. 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. Getting it right august 2016 subscriber webinar the plan for this session 1. General inpatient care gip is available to all hospice. Inappropriate gip billing occurred more commonly in forprofithospices and for gip. In general, it was insufficient documentation in the hospice s medical records to show increased pain and symptom management that would justify the gip level of care. 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. General inpatient gip care is one of the four levels of hospice care required to be. When hospice coverage is elected, the beneficiary waives all rights to medicare part b payments for services that are related to the treatment and management of their terminal illness during the period the hospice benefit election is in force. A physicians guide this reference guide was first published by the minnesota hospice organization, and contained information specific to hospice programs in minnesota as well as data. Hospice quickflips cgs version and millions of other books are available for amazon kindle. Nahc and its affiliate, the hospice association of america haa, reminds hospices that the gip level of care is short term and intended to provide pain and symptom management.
Table 1 presents the locations of care of hospice patients prior to their hospice stay, at hospice admission, and at discharge after hospice enrollment. These areas are evaluation, discharge planning and documentation. Feb 25, 2015 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. Is there documentationthat treatments tried inthe home were ineffective. Identify the regulatory requirements for general inpatient level of care 2. The generous contributions of two other individuals. A companion report will look at the appropriateness ofhospice general inpatient care provided to beneficiaries. Resource guide for general inpatient gip level of care. Hospice clinical documentation hospice benefit available to. Hospice coverage clinical documentation requirement for hospice coverage. The office of inspector generals 2016 report on hospice general inpatient care gip indicated a high rate of misuse of gip services. Instead give the number of meals that the patient ate per day along with the % of intake of each meal.
Documentation of appetite appetite usually is a good indicator of decline in a hospice patient. Is the patient moving from an inpatient hospitalstay to a hospice facility. Industry best practice also states that hospice providers are obtaining a physicians order to change the level of care. 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. Terminal prognosis of 6 months or less lcd criteria days in any billing period without corresponding documentation showing eligibility are unpaid. Welcome choosing to start hospice care is a difficult decision. Hospice documentation that protects your reimbursement 1 kinnser thanks annette lee, rn ms hcsd coss, for authoring this guide. If the patient is moving from an inpatient hospital stay to a hospice facility, the documentation must clearly show why there is a continued need for gip level of care. Characteristics of hospice patients utilizing hospice facilities. Nikki fuller, rn, legacy hospice corporate nursing director 012014. The documentation should always reflect working towards a lower level of care with discharge planning evident from the first day of the gip admission. A nurse, msw, ch, hospice physician, pharmacist, and an aide, who initiate and guide the poc.
Typically, there was insufficient evidence of unmanaged symptoms warranting gip level of care. Medicare reimburses the hospice gip level of care at a set rate. Once the patient is admitted to gip the hospice team must document. The end of the gip building era in the early years of my work as a hospice consultant, i spent a great deal of time conducting hospice facility feasibility studies. Hospice is a concept of care for you and your family. If the hospice and the caregiver, working together, ar e no. Utilize the audit tool to ensure regulatory compliance and a focus on improving the quality of care 3. Aug 26, 2009 a recent whistleblower lawsuit highlights gips status as a hospice hot spot. This beneficiary could have been cared for at home, but the hospice billed medicare for 46 consecutive days of gip. 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. Be able to document a patients eligibility for gip or continuous care. 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.
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. 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. It is the individuals or representatives choice to revoke the election of hospice care without undue influence from you. Hospice election statements lack required information or have. Hospice as noe must be filed within five days and must clear before hospice b can file their noe. The information in this booklet and support from a doctor and. Many of my clients were freestanding nonprofits, i. This session will improve the participants understanding of both the conditions that make patients eligible for gip, and adequate documentation of gip. Incorporate the results of the audit tool as part of their quality improvement program 2. Does the documentation clearlyshow why there is a continued need for gip level of care.
Conversations between hospice and hospital gip staff this documentation should be made available to hospital gip staff. Regulatory explore the many tools and resources that help you understand and comply with state and federal regulations, all delivered in plain english. 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. Our hospice has a fair number of hospital gip admissions in a large city area. The patient has already been at a higher level of care per medicare billing and the. In 2012, she edited patty wus palliative medicine pocket companion, second edition. There is no 48hour period stated in the regs, i think that is a policy of your hospice. Oig puts the pressure on as hospice fraud cases pile up. Hospice payment system mln booklet an individual or representative may revoke the election of hospice care at any time. Patient record must support documentation in technical elements.
Kathy ligon, md, is boardcertified in both internal medicine and hospice and palliative medicine, and. Request for information rfi regarding the role of hospice and coordination of care at the end of life updates to the hospice quality reporting program hospice qrp proposed rebasing of chc, irc, and gip payment rates for fy2020 over recent years cms has been analyzing hospice cost report data and other available information to. Providing gip produces outcomes regarding patientfamily satisfaction, disenrollment from hospice, andor continuity of care. The hospice general inpatient level of care criteria, service. First, you need to thoroughly evaluate the need for the gip level of care. About 7% of hospice patients at admission were placed in the hirf, while 14% were discharged from the hirf.
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