The Secret is Out: Hospice Recertification Made Easy!

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Sometimes hospice patients live longer than six months. When this happens, you’ll want to use these tips to document the hospice recertification with ease.

If you’ve worked long enough as a hospice nurse, then there’s a good chance you’ve had to chart a patient’s hospice recertification. However, did you know that only the hospice medical director can recertify your patient’s eligibility?

Yep, you heard me right. While the nurse practitioner can perform the face-to-face visit, it is up to the hospice medical director to review the documentation and certify the patient still meets hospice criteria.

Now, you might be wondering what your role is in the hospice recertification. Well, it’s quite simple. You’re like the detective gathering all the clues (information) from the past several months to support changes in the patient’s condition.

Let’s talk about benefit periods and then I’ll share tips you can use to prepare for your patient’s hospice recertification.

How Hospice Benefit Periods Work

The initial benefit period starts when the patient signs up for hospice and lasts for 90 days. After the first 90 days, if the patient is still alive and meets qualification requirements, they will be approved for an additional 90 days.

Sound familiar? Two 90-day benefit periods are equal to 6 months and align with the hospice benefit that states a patient is eligible for hospice if their physician certifies their life expectancy is six months or less if the disease follows its normal course. The first two benefit periods don’t require an in-person or face-to-face visit from the hospice medical director.

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Now, what happens if the patient lives past the first two 90-day benefit periods?

Well, they will need to be recertified and seen by the hospice physician or nurse practitioner for an in-person visit also known as a face-to-face. You may also see this written as F2F.

If the patient meets eligibility criteria, then they may be recertified for an additional 60 days. Since the hospice benefit does not expire, patients may continue to be recertified every 60 days.

RECOMMENDED ARTICLE: Hospice IDG Top Time Wasters & How to Avoid Them

What Hospice Recertification Means For You

First, your role is to ensure that your documentation accurately describes the patient’s changes over the duration of the benefit period.

Just so you know, I’m cringing as I write this next sentence!😝

It’s up to you to “paint the picture.” Honestly, I get sick of this overused term in hospice, but it is true.

You will need to master negative charting and understand hospice scales to capture the changes and decline that have occurred in your patient.

You can also use the information from your admission and previous interdisciplinary group (IDG) meetings to help you document.

5 Tips for EASY Hospice Recertification

1. Use Comparison Documentation

Comparison is king in the hospice recertification period. Simply put, you must compare the present to the past. This includes any scale that was used for the patient’s admission to now.

For instance, if your patient was admitted with dementia, you’ll need to show who their FAST score is different (worse) than upon admission.

Other comparisons include mid-upper arm circumference and weight.

2. Address Functional Status

In addition to scales, you will want to give specific information about appetite, activities of daily living, and bowel/bladder. For example, if your patient was eating 50% upon admission and able to feed themselves, and now they require assistance with feeding and are only eating 25%, you should state it in detail.

It is NOT OK to say appetite is declining. This sentence doesn’t tell a story and therefore does not support eligibility.

3. Document Changes in Care

Let me start by saying that all changes that show decline is important. So, think hard about what you see. Sometimes, when you see the patient every week, you might start to miss subtle changes.

An example of this could be that your hospice aide has requested a change in diaper size for the patient. Perhaps, the patient has had changes in their medications due to lack of tolerance or increased pain. These are all items that can support hospice recertification.

4. Report Level of Care Changes

Sometimes, your patient may need a different level of care, and this should be noted. For example, if the patient needed GIP due to uncontrollable symptoms, this will be an essential piece of the puzzle.

Additionally, if your patient requires more frequent visits or now requests the services of spiritual care or social work, this can support recertification.

Another change could include the need for fall precautions that did not previously exist.

5. Document New Orders

In addition, to all the physical changes, you will want to document new orders. If the patient has new orders for equipment, oxygen, therapy, etc., then you will want to capture that as well. Medications may also be discontinued due to changes in the patient’s condition. Another order could be for antibiotics for a urinary tract infection.

Hospice Recertification Example:

90 y.o. male patient admitted with Alzheimer’s dementia resides at NH

Physical: Patient requires full assist with feeding, eating 25% of meals, was eating 50% last period. Continued weight loss, down 4lbs since last IDG to 120lbs

ADLS: dependent in all ADLs; frequently agitated; occasionally delusional. Bathing patient now requires two individuals due to heightened agitation.

INTERVENTIONS: patient needs additional HHA time due to inability to perform all ADLs, previously she was able to assist with ADLs.

Scales: FAST 7B was 7A, PPS-30% was 40% ADLs MID UPPER ARM CIRCUMFERENCE: 21 was 23

Plan of Care: HHA visit frequency increased due to the need for more assistance. Increase aide visits to 3 times per week.

Medication Changes/New orders: Ativan has been increased from 0.5mg q6h to 0.5mg every 4 hours PRN due to increased agitation and the current dose wasn’t effective.

While there is so much more that can be included in the recertification, the topics mentioned above will give you a good start. Remember, it’s all about capturing the data and telling the patient’s story. And one last thing, you should document it even if it seems like a small change.

AVOID Hospice Recertification Red Flags

There’s one last thing you should be aware of, and that is red flags. When a hospice patient is enrolled for a long period of time, this can result in increased scrutiny of your documentation. You should also be aware that if your patient’s hospice recertification is late or falls out of the prescribed Medicare guidelines, their recertification can be denied. You want to avoid this at all costs.

It’s a sad fact that many hospices lose revenue every day because of poor documentation and untimely recertifications. To be frank, this impacts many factors beyond the bedside like pay increases and the bottom line. If you’ve ever been frustrated, then this is the time!

Summary

Lastly and most importantly, chart your patient’s decline. It’s what matters when you’re trying to justify recertifying your patient. Also, make sure you’re telling the whole story of the benefit period. A surveyor should be able to go back through your notes and see the decline regardless of how gradual. Remember, you’re Sherlock Holmes and it’s up to you to uncover the details so the patient can be recertified.

5 Tips for Hospice Recertification

• Use Comparison Documentation
• Address Functional Status
• Documents Changes in Care
• Report Level of Care Changes
• Document New Orders