A: The law requires that a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient prior to the third recertification period and for every subsequent period. Unless one of the exceptional conditions described below is met, failure to meet the encounter timeframes results in a failure by the hospice to meet the patient’s recertification of terminal illness eligibility requirement. At that point, the patient would cease to be eligible for the Medicare Hospice Benefit. The hospice may continue to serve the patient under hospice care, but in doing so assumes all financial responsibility for that care. The patient can be re-admitted when the eligibility criteria are met.
When must a hospice physician have a face-to-face encounter with a patient?
For recertifications on or after January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient prior to the beginning of the patient's third benefit period, and prior to each subsequent benefit period.
What is the ACA requirement for Hospice Physicians?
The Affordable Care Act (ACA) requires that a hospice physician or nurse practitioner (NP) must have a face-to-face encounter with every hospice patient to determine the continued eligibility of that patient prior to the 180thday recertification, and prior to each subsequent recertification. The provision is effective January 1, 2011
What happens if you don’t meet hospice requirements?
When the FTF requirements are not met, the patient is no longer eligible for the Medicare hospice benefit. The FTF encounter must occur within 30 calendar days prior to the start of the 3rd benefit period and each subsequent recertification.
When does a FtF encounter become complete in hospice?
In addition, if the patient dies within 2 days of admission, a FTF encounter is considered to be complete. When a required face-to-face (FTF) encounter does not occur timely, the beneficiary is no longer certified as terminally ill, and therefore, is not eligible for the Medicare hospice benefit.
How long is a face to face good for in hospice?
The FTF encounter must document the clinical findings supporting a life expectancy of 6 months or less. When the FTF requirements are not met, the patient is no longer eligible for the Medicare hospice benefit.
Can someone on hospice be left alone?
Can I still get hospice care if I live alone? It is possible to get hospice care if you are used to living alone. Special considerations will have to be addressed, however.
Can a PA do a hospice face to face?
NPs, while not permitted to recertify terminal illness, are permitted to conduct the face-to-face encounter to determine continued eligibility. PAs are not given the ability to conduct this face-to-face encounter.
What are the 4 levels of hospice care?
Every Medicare-certified hospice provider must provide these four levels of care:Hospice Care at Home. VITAS supports patients and families who choose hospice care at home, wherever home is. ... Continuous Hospice Care. ... Inpatient Hospice Care. ... Respite Care.
Does hospice sit with patients?
For the most part, the Medicare home hospice benefit is intended for patients and families that can handle a patient's personal care needs with some intermittent support. Also, home hospice is only appropriate for patients whose medical needs can be satisfied by numerous home visits and 24/7 on-call nursing.
What medications are allowed on hospice?
Common Hospice MedicationsAcetaminophen. ... Anticholinergics. ... Antidepressant medications. ... Anxiolytics. ... Atropine Drops. ... Fentanyl. ... Haldol (also Known as Haloperidol). ... Lorazepam (Ativan).More items...
When should a face to face encounter occur?
In such documented cases, a face to face encounter which occurs within 2 days after admission will be considered to be timely. Additionally, for such documented exceptional cases, if the patient dies within 2 days of admission without a face to face encounter, a face to face encounter can be deemed as complete.
What is a CTI in hospice?
The Hospice Medicare CTI Audit Tool allows Hospice providers to audit the certification of terminal illness for all technical requirements. The Hospice Medicare Election Audit Tool allows Hospice providers to audit the Medicare election statement for all technical requirements.
What is 1 role of the attending physician for hospice care?
Once the decision to refer to hospice is made, the family physician typically continues to be the patient's primary attending physician. The attending physician is expected to remain in charge of the patient's care, write orders, see the patient for office visits, and complete and sign the death certificate.
Can you be on hospice for years?
A. You are eligible for hospice care if you likely have 6 months or less to live (some insurers or state Medicaid agencies cover hospice for a full year). Unfortunately, most people don't receive hospice care until the final weeks or even days of life, possibly missing out on months of helpful care and quality time.
How long does the average hospice patient live?
Location: Patients admitted to hospice from a hospital are most likely to die within six months. Those admitted from home are next most likely to die within six months and those admitted from nursing homes are least likely.
Does hospice give IV fluids at home?
Usually in our hospice care in Central Ave Riverside California, our patients who are very close to reaching the sunset of their lives may want their feeding tubes removed or it can be done by family members or the patient's doctors themselves. Can a patient receive IV fluids? Yes.
What happens when you choose hospice care?
When you choose hospice care, you decide you no longer want care to cure your terminal illness and/ or your doctor determines that efforts to cure your illness aren't working . Once you choose hospice care, your hospice benefit will usually cover everything you need.
How long can you be in hospice care?
After 6 months , you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you’re still terminally ill. Hospice care is usually given in your home but may also be covered in a hospice inpatient facility. Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is unusual. When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working. Once you choose hospice care, your hospice benefit will usually cover everything you need.
How long can you live in hospice?
Things to know. Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies ...
What is hospice care?
hospice. A special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient's family or caregiver. care.
What is Medicare approved amount?
Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. for inpatient respite care.
Can you stop hospice care?
As a hospice patient, you always have the right to stop hospice care at any time. Prescription drugs to cure your illness (rather than for symptom control or pain relief). Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose.
Can you get hospice care from a different hospice?
You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care. Room and board.
When do you have to face to face with hospice?
The required face-to-face encounter must occur prior to the start of the beneficiary's third hospice benefit period and again prior to all subsequent benefit periods. As Medicare beneficiaries have an unlimited number of benefit periods available to them, hospice providers must, prior to admitting hospice beneficiaries, ...
When does a hospice nurse practitioner have to meet with each patient?
The benefit manual states: For recertifications on or after January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient prior to the beginning of the patient's third benefit period, and prior to each subsequent benefit period .
What happens if a provider fails to meet the face to face requirement?
In other words, if the provider fails to meet the "face-to-face" encounter requirement prior to the third benefit period, and prior to each subsequent benefit period, the provider should be financially responsible for rendered care. To avoid future confusion, the Medicare policy manual should be amended to address this issue.
Is hospice face to face?
Hopefully the "face-to-face" encounter will have the desired effect of encouraging increased physician involvement not only with the certification process, but with overall care of hospice patients. However, this new requirement still creates the unresolved concern that it makes caring for hospice patients in their third and subsequent certification periods more difficult and potentially more expensive for providers than caring for patients in their first and second certification periods. This could create a significant barrier to care for dying Medicare beneficiaries and is therefore an issue that must be closely watched.
Does Medicare cover hospice care?
Eligibility for Medicare coverage of hospice care is contingent in part upon a hospice physician certifying that the beneficiary has a life expectancy of six months or less if the terminal illness runs its normal course. In an effort to promote physician engagement in the process of certifying patients as eligible for the Medicare hospice benefit, Congress amended § 1814 (a) (7) of the Social Security Act, by § 3132 of the Affordable Care Act, to require a face-to-face encounter by a hospice physician or nurse practitioner with every hospice patient to determine the continued eligibility of that patient prior to the 180-day recertification, and prior to any subsequent recertification. Furthermore, the law requires that the hospice physician or nurse practitioner attest that such a visit took place.
Can hospice patients face to face?
In cases where a hospice newly admits a patient who is in the third or later benefit period, exceptional circumstances may prevent a face-to-face encounter prior to the start of the benefit period. For example, if the patient is an emergency weekend admission, it may be impossible for a hospice physician or [nurse practitioner] ...
Do you have to file election statements with Medicare?
There is currently no mandate requiring that providers immediately file election statements. At this time, providers must file the election statements with their Medicare contractors prior to the time they bill, but they have one year to bill for rendered care. This flaw creates significant lag time in the system's accuracy and if not remedied, ...
Can a hospice face-to-face encounter occur on the same day that the new hospice benefit period begins?
Yes. The hospice face-to-face encounter must occur prior to, but no more than 30 calendar days prior to, the 3rd benefit period recertification, and every benefit period recertification thereafter. The face-to-face encounter is one part of a hospice recertification, so a recertification is not complete until it occurs.
When a hospice patient goes to a hospital for care for the terminal illness or related conditions without the hospice arranging for it, who is responsible for the bill?
For the duration of an election of hospice care, an individual waives all rights to Medicare payments for any Medicare services that are related to the treatment of the terminal condition for which hospice care was elected, or a related condition.