Tag: Medicare Compliance

Articles about maintaining Medicare compliance in the field of hospice.

Understanding Emergency Admissions in Hospice

Daughter And Staff Around Dying Elderly Woman
Emergency admissions in hospice provide rapid care for patients nearing the end of life. This process involves quick referrals, expedited assessments, and immediate provision of necessary equipment and medications. Hospice teams work efficiently to ensure patients receive comfort and support during this critical time.
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Hospice Eligibility for Diverse Dementia Diagnoses

Differential Diagnosis for Dementia
Exploring Hospice Eligibility Criteria for Alzheimer's, Vascular, Lewy Body, Frontotemporal and other Dementias: Empowering Hospice Nurses to Provide Compassionate End-of-Life Care
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How RN Case Managers Can Maintain Good Compliance with Medicare Guidelines

As a seasoned hospice nurse, I recognize the significance of adhering to Medicare guidelines to ensure top-notch patient care. Medicare guidelines offer a roadmap for hospice providers to offer exceptional care to terminally ill patients and their loved ones. Nonetheless, upholding compliance with these guidelines can be a hurdle, especially for smaller hospice providers with limited resources. In this article, we'll delve into how RN case managers can effectively ensure compliance with Medicare guidelines.
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Understanding Hospice Eligibility for Terminally Ill Patients with Non-Alzheimer’s Dementia

Navigating hospice eligibility for non-Alzheimer's dementia patients demands a personalized approach. Unlike Alzheimer's, there's no definitive scale, necessitating assessments of functional decline, mobility, communication, incontinence, weight loss, overall condition, and comorbidities. Effective documentation, clinical judgment, and compassionate care are crucial for supporting these patients and families.
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Avoiding Problematic Language in Hospice Nursing Narratives

Proper documentation is crucial for hospice nurses to ensure Medicare compliance and maintain the patient's eligibility for services. Auditors, who may not have a healthcare background, review these documents to determine if the patient's condition is terminal. To avoid having the patient removed from service due to improper documentation, hospice nurses should be mindful of the words and phrases they use in their nursing narratives and progress notes. This article will guide what to avoid and why it is essential to paint a picture of a terminally ill patient.
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Understanding Heart Failure Stages and Assessment

Heart failure is a complex medical condition that can impact the quality of life of patients, especially those in hospice care. As a hospice nurse, assessing the heart failure stage is crucial to providing appropriate care accurately. This article will explore the New York Heart Failure Classification System, its stages, and how to assess patients for their stages. Additionally, we will emphasize the importance of documentation in compliance with Medicare guidelines for terminally ill patients with heart failure.
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Reviewing Hospice Eligibility

general hospice criteria
It’s essential to familiarize yourself with the key local coverage determination (LCD) facts for different terminal illnesses to avoid admitting patients who are not eligible for services only to be required to refund the money back to Medicare; otherwise, only have the patient on for one benefit period then discharged for failure to decline. These determinations provide guidelines on the coverage of hospice services for specific conditions. If you are the admitting nurse, please do not just admit because you were told to admit by someone, regardless of the position or standing of the person or party that told you to admit. Use your critical thinking and clinical judgment skills to evaluate the patient for admission. Most doctors will write "evaluate and treat" or something to that effect; never lose sight of the "evaluate" portion of the doctor's order. Based on the provided PDF files, as noted in the resources section below, let’s explore some essential information for each terminal illness.
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Empowering Hospice Nurses: Conquering Medicare Audits and Improving Documentation for Better Patient Care

This article provides valuable insights for hospice nurses on improving documentation to conquer Medicare audits and ensure claims are not denied due to insufficient evidence of terminal prognosis. The author shares real-life examples of visit narratives before and after implementing documentation best practices learned from an expert. The tips focus on capturing negative condition changes, disorientation levels, and functional decline to paint a clear picture of the patient's terminal state, ultimately leading to better patient care.
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Review of the Hospice Documentation Master Bundle

Whether you are a new hospice nurse or an experienced one like me, I would hope that it is your desire to prove and support continued hospice eligibility for your patients and families. In my years as a hospice nurse, I've always felt the training on what words and phrases to use to support hospice eligibility was weak compared to the training received in other areas of nursing. Now, you have a means of getting the education you need in a very portable setup that you can take with you, use as you see fit, and bloom!
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Understanding HIS Requirements for Medicare in Hospice Care

One crucial aspect for new hospice nurses to grasp is the Hospice Item Set (HIS) requirements. In this article, I’ll explain the HIS requirements for Medicare, providing you with a comprehensive understanding to ensure compliance and quality care delivery.
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The Hospice Nursing Visit from a Nursing Perspective — Home Patients

This article offers guidance for new visiting hospice nurses struggling with work-life balance. It covers strategies like maintaining a recertification journal, pre-charting before visits, assessing end-of-life status, educating families, and preparing for a "good death." By following these tips, nurses can take less work home while delivering focused, compassionate care.
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The Importance of Documenting Hospice Visits at the Bedside

Our primary focus for our patients is comfort at the end of life as hospice nurses. We work tirelessly to ensure that our patients receive the best possible care during their end-of-life journey. An aspect of that care that is often overlooked, but incredibly important is timely documentation. Documenting hospice visits at the bedside is crucial for several reasons. Not only does it help ensure that our patients are receiving the best possible care, but it also helps the hospice team as a whole and reduces issues when the caregiver must be involved in triage services. Here are just a few reasons why documenting hospice visits at the bedside is so important:
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General Inpatient (GIP) Level of Care for Hospice Explained

general inpatient hospice
GIP, or General Inpatient Hospice, is an often misunderstood aspect of hospice care. Both hospital staff and families sometimes have misconceptions about GIP. Families may assume it's readily available upon request, while hospital professionals may believe it allows patients to remain in the hospital indefinitely, even when death is weeks away. This article will clarify the basics of GIP for hospice, including eligibility requirements, doctor's orders, care plans, documentation, and education. We'll conclude with two real-life cases to illustrate these points.
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Tips for new hospice nurses doing an admission

If you are a new nurse to hospice, one of the tasks you probably dread is doing an admission especially if you have scheduled visits the same day as the admission. I would like to share with you some tips that when applied may help lower your stress level, and help you remain on time even in cases where you have three to four visits including recertification to do the same day.
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