Hospice: Conditions for Payment

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Video Runtime: 42 Minutes; Learning Assessment Time: 24 Minutes

Hospice clinicians must understand what the Medicare hospice benefit entails, as well as the conditions for this benefit. This session will clearly define all of the technical necessities and clinical indications for the hospice benefit and equip learners with the actual CMS citations so they can be the tiebreakers at their agencies, using CMS rules for decision-making and documentation.

Meet your instructor

Annette Lee

Annette is a registered nurse who has been practicing since 1990, with the majority of her nursing experience being in public health care. She has a master’s degree in health care administration. In 2000 she joined the home health intermediary Cahaba GBA, where she became an instructor, providing education to home health and…

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Chapters & learning objectives

1. Hospice: Medicare Coverage Rules (The Who/What/When of Medicare Payment)

It is important for hospice clinicians to have the foundational rules and guidance to ensure consistency and compliance with the conditions for payment. There are many myths about this in hospice because many agencies provide orientation by oral tradition rather than using written, sourced evidence. This chapter will introduce the rulebook of coverage: the Medicare Benefit Policy Manual.

2. What Are the Hospice Conditions for Payment?

This chapter will describe each of the conditions of payment and the details that must be clear in documentation of these components, including election, certification, FTF (after 180 days), prognosis, POC update, and level of care.

3. Payment Protection

This chapter will explain how to ensure the hospice is compliant with the Medicare conditions for payment and can support those conditions by using a payment checklist to perform pre-bill audits. This chapter will also identify ways to create tools for orientation and education for all hospice staff, highlighting the conditions for Medicare coverage to ensure a culture of compliance.

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