Category: Hospice Documentation
Hospice Targeted Probe and Educate – Avoid Claim Denials
By Leslie Heagy, RN, COS-C / Posted on: February 25, 2020Targeted Probe and Educate (TPE) is continuing to be a problem for Hospice providers with some advancing to rounds 2 and 3 of the audit. This demonstration, which includes hospices receiving 20-40 claim requests for Additional Development Requests (ADR) in each round, have hospices wondering if they are going to be targeted next. In order to avoid advancing to the next round of TPE, the hospice’s calculated error percentage at the end of each round must be less than the percentage set by the MAC.
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Documenting Hospice Eligibility for a Cardiopulmonary Diagnosis
By Leslie Heagy, RN, COS-C / Posted on: February 4, 2020When documenting hospice eligibility for a cardiopulmonary diagnosis you MUST go beyond the disease-specific LCD guidelines to avoid denial under medical review. Many people who suffer from advanced cardiopulmonary disease share multiple symptoms as the disease progresses, however, the symptoms affect each patient differently and therefore, must be documented this way in order to support each patient’s terminal condition.
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Targeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons
By Melinda A. Gaboury, CEO / Posted on: May 30, 2019As long as hospices are carefully documenting the details of each patient’s clinical situation and each patient meets the eligibility requirements for hospice care—these denials are avoidable. Don’t be the hospice that gets technical denials for careless mistakes, like incorrect format of the election statement or completing CTIs with boxed/canned statements that are not specific to the patient.
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8 Major Changes Outlined in the FY2020 Hospice Wage Index Update
By Leslie Heagy, RN, COS-C / Posted on: May 3, 2019The FY2020 Hospice Wage Index & Payment Rate Update & HQRP Proposed Rule presents significant changes to rates and election statements. This proposed rule needs our full attention and comments! Please do your part and comment by the deadline stated in this article.
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Documenting Hospice Eligibility for Alzheimer’s Dementia
By Leslie Heagy, RN, COS-C / Posted on: March 22, 2019When admitting a patient to hospice with a primary terminal diagnosis of Alzheimer’s disease, your documentation should clearly show the nature and condition causing the hospice admission in addition to, the hospice disease-specific LCD guidelines.
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Required Hospice GIP Documentation
By Leslie Heagy, RN, COS-C / Posted on: February 4, 2019General Inpatient (GIP) Care is one of the four levels of care available to patients who elect the Medicare Hospice Benefit. When may GIP level of care be appropriate? When is it NOT appropriate to use GIP level of care?
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Top Denial Reasons – Hospice Targeted Probe and Educate
By Leslie Heagy, RN, COS-C / Posted on: September 11, 2018Targeted Probe and Educate (TPE) is underway for Hospice Agencies. HPS is seeing many ADR denials with agencies moving to round 2 and 3 of TPE from both CGS and NGS.
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Targeted Probe and Educate – What We Have Learned So Far
By Melinda A. Gaboury, CEO / Posted on: March 13, 2018Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.
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Preparing for Hospice Targeted Probe and Educate (TPE)
By Katie Wehri / Posted on: October 31, 2017As previously reported, the targeted probe and educate (TPE) process is replacing the medical review process used by Medicare Administrative Contractors (MAC). Each of the three MACs – Palmetto GBA, NGS and CGS – can choose the topics for review under TPE based on existing data analysis procedures.
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Hospice CTI and Election Statement Made Easy
By Katie Wehri / Posted on: October 16, 2017CMS reminded hospices recently about the need to comply with Medicare hospice election statements and certification of terminal illness (CTI) requirements. This reminder comes shortly after CMS’ announcement of the expansion of the targeted probe and educate (TPE) method of medical review to hospices and other provider types. We believe there is a strong possibility that CMS will…
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Targeted Probe and Educate
By Melinda A. Gaboury, CEO / Posted on: September 25, 2017HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.
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Hospice Quality Reporting Program Update – HIS and Hospice Compare
By Katie Wehri / Posted on: June 16, 2017CMS recently released clarification of the response options for HIS item A1400, Payor Information. Many hospices have been asking how to complete this item with questions about the Self Pay option, in particular. In addition to the information in the HIS Manual, CMS provides the following additional information specific to the…
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Attending versus Referring Physician in Hospice
By Katie Wehri / Posted on: June 1, 2017A physician refers a patient to hospice care – what role does this physician play in the care of the patient and in certifying the patient? It depends. Let’s look at the various hospice requirements that involve a physician.
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HIPAA for Home Care | Establishing A Compliant Agency
By Drew Rowley / Posted on: March 3, 2017HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?
VIEW POSTHospice CAHPS Surveys Will Affect Payment
By Melinda A. Gaboury, CEO / Posted on: January 29, 2016…
VIEW POSTNew G-Codes Not JUST for HOSPICE!
By Melinda A. Gaboury, CEO / Posted on: October 23, 2015…
VIEW POSTInitials and Not a Full Signature, Allowed?
By Melinda A. Gaboury, CEO / Posted on: October 9, 2015…
VIEW POSTHome Care and Hospice: Still No Relief!
By Melinda A. Gaboury, CEO / Posted on: September 11, 2015…
VIEW POSTHospice Update on Attending Physician
By Melinda A. Gaboury, CEO / Posted on: May 20, 2015…
VIEW POSTAre You Convinced Your Agency is ICD-10 Ready?
By Melinda A. Gaboury, CEO / Posted on: April 1, 2015…
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