The Hospice CHAPS Education edition of valuable insights by our own hospice & palliative professionals covers the following CAHPS survey question:
Discharge from Hospice
Q: What are the three reasons a hospice may discharge a patient?
1. The patient moves out of the hospices service area or transfers to another hospice.
Examples of moving out of the service area include:
- When a hospice patient moves to another part of the country
- When a hospice patient leaves for a vacation.
- When a hospice patient receives treatment for a condition unrelated to the terminal illness or related conditions in a facility with which the hospice does not have a contract, and the hospice is unable to access the patient to provide hospice services.
2. The hospice determines that the patient is no longer terminally ill (extended prognosis)
- In this situation, the hospice will be unable to recertify the patient. The beneficiary can ask the Quality Improvement Organization (QIO) for an expedited review of the discharge
3. The hospice determines, under a policy set by the hospice for the purpose of addressing discharge for cause, that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient is seriously impaired. There are a number of steps that must be followed to try to mitigate the problem before a discharge for cause can be done, and this type of discharge is very rarely done.
These situations would include issues where patient safety or hospice staff safety is compromised. When a hospice determines, under a policy set by the hospice for the purpose of addressing discharge for cause, that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired, the hospice can consider discharge for cause.
The hospice must do the following before it seeks to discharge a patient for cause:
1. Advise the patient that a discharge for cause is being considered
2. Make a serious effort to resolve the problem(s) presented by the patient’s behavior or situation
3. Ascertain that the patient’s proposed discharge is not due to the patient’s use of necessary hospice services
4. Document the problem(s) and efforts made to resolve the problem(s) and enter this documentation into the patient’s medical records.
The hospice must notify the Medicare contractor and State Survey Agency of the circumstances surrounding the impending discharge. The hospice may also need to make referrals to other relevant state/community agencies (i.e., Adult Protective Services) as appropriate. Discharge order: Prior to discharging a patient for any reason other than a patient revocation, transfer, or death, the hospice must obtain a written physician’s discharge order from the hospice medical director. If a patient has an attending physician involved in his or her care, this physician should be consulted before discharge and his or her review and decision included in the discharge note.
Revocation of Hospice Benefit
Hospice cannot “revoke” a patient. A revocation is initiated by the patient or their responsible party.
Upon discharge or revocation of hospice care, the beneficiary immediately resumes the Medicare coverage that had previously been waived by the hospice election. As such, hospices should record the beneficiary’s discharge or revocation in the claims processing system promptly. If a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, the hospice shall submit a timely-filed Notice of Termination/Revocation (NOTR) unless the hospice has already filed a final claim. A timely-filed NOTR is a NOTR that is submitted to and accepted by the Medicare contractor within 5 calendar days after the effective date of discharge or revocation. Hospices continue to have 12 months from the date of service in which to file their claims.
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