The Office of the Inspector General (OIG) noted that hospice election statements lacked required information or had other vulnerabilities in more than one-third of general inpatient care stays. Notably, many did not mention, as required, that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative. Please see MLN Matters Special Edition Article SE1628 for requirements about hospices and election statements. Model Medicare Hospice Election Statement language is included at the end of this article.
This article is intended to provide guidance on the requirements for a valid physician certification and recertification. Any examples provided in this article are for illustration purposes only and do not in any way imply this is the only acceptable format. Hospice providers may choose to design their own forms or format, so long as all requirements of a valid physician certification are met.
Please remember that although Palmetto Offices may be closed for Holidays, your NOE’s for hospice are still due by the 5th calendar day after admission.
The Palmetto GBA Provider Contact Center (PCC) will continue to close up to eight hours per month for customer service representative (CSR) training and staff development. Please note that our Interactive Voice Response (IVR) unit will be available during these scheduled training sessions for automated customer service transactions. You may use our online provider portal called eServices to obtain claim status, duplicate remittances, patient eligibility and much more. Register now at www.PalmettoGBA.com/eServices . Listed below are training closure dates and times.
|November 24-25, 2016||Office closed/Thanksgiving|
|December 2, 2016||PCC closed 8 a.m. to 12 p.m.|
|December 16, 2016||PCC closed 8 a.m. to 12 p.m.|
|December 23, 2016||Office closed/Christmas Eve|
|December 26, 2016||Office closed/Christmas Day|
|January 2, 2017||Office closed/New Year’s day|
Please note that we will attempt to provide advance notice of any changes to the above training schedule via the website, IVR features and automatic email notices.
If you have not already done so, we encourage you to sign up for automatic email notices of updates to our website. Subscribing to this listserv is the fastest way to find out about Medicare changes that may affect you. There is no charge for the service, and we will not share your email address with others. To register, go to Email Updates on our website.
If you have any questions, please contact our Provider Contact Center at our toll-free number at 855-696-0705. For information regarding claims status or eligibility, please call the Interactive Voice Response (IVR) at 855-696-0705 or use Palmetto GBA’s eServices tool.
During this time of year, missed visit questions tend to come up more frequently. Based on many years of survey experience, these questions and answers have been compiled as a guide.
Example is Patient is set up with an ordered frequency is 2 visits per week (Sunday-Saturday)
These are examples of what happens where “hands on visits” do not occur.
Q1. Go to client location, they are not home. Fill out missed visit report. Does this count against frequency per MCR?
A1. This was an attempted visit (hopefully it was previously scheduled with patient). So, it would satisfy the frequency if a missed visit is documented, stating the attempt.
Q2. Did not get to patient for a visit at all–just not enough time, and no time to make up before the end of the Medicare week. Filled out missed visit report. Does this count against frequency per MCR?
A2. There was no attempt made, so frequency was NOT met and the visit needs to be made up during that Medicare week (Sunday-Saturday).
Q3. Family says does not want visit for Thanksgiving Day, Friday, or Saturday. Do you still have to make 2 visits during Sun-Wed or can one be a missed visit since family refused.
A3. This can be documented as a missed visit as family refused, but does not satisfy the frequency. However, documentation should also be very specific to show that other visits that week were offered to meet frequency, and also refused. Surveyors know that staff can, at times, do this for staff convenience rather than patient convenience, which is not allowed.
Please check with your software vendor to determine how to document each type in the software you use.