Death Knell for Debility and Adult Failure to Thrive as Terminal Diagnoses in Hospice

1085 Words Apr 13th, 2015 5 Pages
The Death Knell for Debility and Adult Failure to Thrive as Terminal Diagnoses in Hospice
May 24, 2013 Terri Maxwell

On May 10, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule entitled FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements; and Updates on Payment Reform [CMS-1449-P]. This rule contains important information, including proposed hospice rates for 2014 (no good news here, rates are going down), changes to the hospice quality reporting program, alterations to the cost report, and an update to hospice payment reform options.
In addition to these proposed changes, CMS “clarified” a number of coding requirements that has had the industry buzzing.
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* Have your Medical Director or Hospice Team Physician review each patient’s clinical record to identify an alternate primary diagnosis. Tips to identifying an alternate diagnosis include: 1. Review the Plan of Care (POC) to determine the body system, symptoms and psychosocial/spiritual issues that require the greatest amount of palliative interventions. 2. Review the drug profile to identify what medications are being used and for what purpose. 3. Ask yourself, if the patient died tomorrow, what would the physician list as the cause of death on the death certificate? * When changing a patient’s primary hospice diagnosis, remember to do the following: 1. Obtain a physician order for the new diagnosis. 2. Obtain a new physician narrative that paints the picture for eligibility for the new diagnosis that is supported by documentation in the clinical record. 3. Develop a new POC based upon an updated comprehensive assessment. 4. Update the drug profile with appropriate designation of related/covered or not related/not covered. 5. Change billing codes. 6. Communicate these changes with staff members, attending physicians, and referral sources, including nursing facilities and assisted living facilities. * The diagnosis can be changed on the next claim, or an adjustment may be made to a prior claim if needed. It is not necessary to cancel any claims already
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