The Importance of Appropriate Admission and Recertification of Patients to Hospice

Abstract

Hospice programs are under increased scrutiny by external regulatory enforcers today. Questions surrounding appropriate admission and recertification of patients to the Hospice Medicare Benefit have raised major concerns regarding patient care delivery, payment of services, and charges of fraud and abuse. To remain viable, hospices must have a thorough knowledge of current legislation, state and federal hospice eligibility and coverage criteria, and internal utilization patterns. Operation Restore Trust and Kennedy-Kassebaum legislation are two products of health care reform that hospices must understand to realize the repercussion of inappropriate admission and recertification of patients to a hospice benefit. The hospice teams' knowledge of eligibility and coverage requirements, National Hospice Organization (NHO) Guidelines for Determining Prognosis in Selected Non- Cancer Diseases, and the correlation between documentation and denial are critical for a successful hospice program today.