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Medicare Compliance & Reimbursement

Hospice Compliance:

Make Sure These Documents Are In Your Nursing Home Patients' Files

Published on Tue Jan 31, 2012

Plus: Help nursing homes use the MDS to identify residents who need hospice services.

Federal authorities will be looking closely at how you interact with the nursing homes where your hospice patients reside. Will your practices pass muster?

When Miami-based VITAS Healthcare Corp. provides care to hospice patients in a nursing home, it makes sure the nursing home has a copy of the hospice election form, says nurse Cherry Meier, a spokesperson for the organization in Flat Rock, N.C. The form "clearly states that the resident/patient and/or responsible party wants to have palliative rather than curative care," she observes.

Remind your nursing home partners that the NOE will help their paperwork. "With the MDS 3.0 focusing on giving the resident a voice, the election form should provide guidance in determining appropriate goals/interventions," Meier says.

Also: If the patient has an advance directive, "make sure it is in the chart so the nursing home knows what the patient wants," Meier advises. "Then the physician's six-month prognosis certification provides validation that palliative care is very appropriate given the person's stage of illness," she explains.

Documentation of face-to-face physician encounter visits "again supports that even if the person is living longer than anticipated, they are eligible for the benefit," Meier says. "We ensure those documents are in the chart and are signed appropriately. If they are not signed appropriately, the facility can't check on the MDS that the person has a six-month prognosis."

Helping hand: The MDS 3.0 includes a question as to whether the resident is admitted to the nursing home from hospice or discharged from the nursing home to hospice. "A third field is checked anytime the resident is receiving care from a licensed or certified hospice. That's why the [hospice] election form is so important to the MDS coordinator as they have proof in the chart and can check those boxes," Meier explains.

Coordinate The Care Plan And ID Eligible Residents At The Same Time

You and the nursing home care team should not be working in two different worlds. "The new rules for the MDS 3.0 make it mandatory for the nursing home to do a significant change assessment on admission or discharge from a hospice," Meier says. And "since a significant change triggers a comprehensive assessment and care plan ... our interdisciplinary team works to help the nursing facility team develop that care plan. That's how we coordinate the care plan right from the beginning of admission to hospice."

Tip: You can help nursing homes identify more patients who are eligible for and would benefit from hospice services. "The MDS 3.0 pain section and mood section are potential indicators that a resident may benefit from a referral to hospice," Meier explains. "When residents talk about being depressed or better off dead or hopeless, etc. -- these are common themes in people who are dying."

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