Documentation of Hospice Related/Unrelated Diagnoses and Coverage Determinations - An Efficient Approach

Summary

Patients electing the hospice benefit typically have many medical conditions. Some conditions contribute to limited life expectancy and some do not. Each condition must be labelled by hospice as “terminal,” “related” or “unrelated.” How conditions are labelled is important. The cost of care (services, DME and medications) for “terminal” and “related” conditions is paid by hospice. However, cost of care for “unrelated” conditions is paid by Medicare outside the hospice benefit.

Regulatory authorities take interest in conditions deemed by hospice to be “unrelated.” Hospice documentation must explain why a condition is so deemed. This presentation outlines an approach to efficient documentation that can be performed easily at the time of patient referral to label all medical conditions.

Learning Objectives

• Efficiently document determination of medical conditions as “terminal,” “related” and “unrelated” at the time of hospice referral.
• Efficiently document hospice benefit coverage determination for services, DME and medications at the time of hospice referral.
• Create a reproducible method to determine hospice benefit coverage determination for medications, services and DME that are not a routine part of end-of-life care.

Speaker:Ronald Manning, MD, Assistant Medical Director, Unity Hospice

Ron Manning has been in medical practice in Northeast Wisconsin since 1999.  As a Physiatrist, he practiced general rehabilitation and musculoskeletal medicine.  He joined Unity Hospice as the Assistant Medical Director in 2014 and since then has practiced end-of-life care full-time.  He is certified through the Hospice Medical Director Certification Board.  He has an interest in developing workflow to meet growing regulatory burden imposed on hospice organizations and to improve hospice field staff’s ability to provide quality care while efficiently meeting regulatory requirements.