Term
Under hospice what does the term "election " mean?
|
|
Definition
| Election means the medicare regulations that the patient or their legal representitative sign election statement at the time of admission to hospice care. Hospice is reimbursed under part A for Medicare patients |
|
|
Term
The home health and Hospice care teams sound almost identical , so how do their services differ?
|
|
Definition
| The difference is the composition of the interdisciplinary team. The team is led by physician , either a Hospice employed physician or the patients attending physician ,who can elect to continue following the patient. The remaining members include , but are not limited to, a nurse , social worker, pastoral or other counselor, and breavement coordinator. Some hospice may also include volunteer coordinator , a pharmacist , or a home health aide. |
|
|
Term
| What are the five elements that are required in /on an election ? |
|
Definition
| 1)The statement must identify the hospice.2.) It must contain a statement that acknowledges that the patient understands the palliative nature of hospice care. 3)The standard coverage for Medicare Services related to the patients terminal diagnosis is wavied.4) The statement must have an effective date .5)The statement must be signed by the patient or legal representative. |
|
|
Term
| What is "palliative "care ? |
|
Definition
| Is symptom management rather than curative therapy to patients who are terminally ill with a life expectancy of less than 6 months. |
|
|
Term
| Do hospices render (palliative) this care to non terminal patients ? |
|
Definition
|
|
Term
|
Definition
| National Hospice and Palliative Case Organization . Publishes a book on standards that can be utilized by hospices to validate the quality of care provided. |
|
|
Term
| What are the hospice benefit periods ? |
|
Definition
| The first benefit period begins on the day of election to hospice (admission). They have 3 benefit periods : intinal one 90day , then a subsequent 90 day followed by an unlimited number of 60 day periods. |
|
|
Term
|
Definition
| Respite care provides an interval of rest for the primary caregiver and is provided to hospice patients in an approved facility (a nursing home , hospital , or hospice house.) |
|
|
Term
| What is the maxium number of days of each respite care period? |
|
Definition
|
|
Term
| Under hospice who is the primary care giver? |
|
Definition
| The patients immediate family/friends act as the primary care giver. |
|
|
Term
| What is the hospice definition of "terminal" ? |
|
Definition
| Someone with a prognosis of six months or less if the illness runs it normal course. It is based on the physicians and medical directors clinical judgement regarding the normal course of the individuals illness. |
|
|
Term
| What are the four levels /types of hospice care? |
|
Definition
Routine home care
General inpatient care
Continuous Care
Inpatient respite |
|
|
Term
| How are the records of active patients organized and where are they typically stored ? |
|
Definition
| The medical record begins with a paper form or face sheet, the h&p , consents , and initial physicians orders. It is housed at the hospice , will be expanded to include the hospice physicians assessment , social work assessment , and an attending physician /hospice medical director signed certification of terminal illness. |
|
|
Term
| The care team is called "interdisciplinary" what does that mean ? How often do they typically get togather and review the care plan ? |
|
Definition
| Interdisciplinary means a group with different clinicial and or training skill sets working togather to provide comfort , quality care for the dying patient. They typically get together once every two weeks. |
|
|
Term
| What are breavement services ? Who recieves them ? And for how long ? Does Medicare pay for this service ? |
|
Definition
| After death of the patient the family of the patient recieve breavement services . Medicare does pay for this service and it last for 13 months. The details of the breavement services are tailored to the familys needs and wants from visits , to counseling , to group therapy. |
|
|
Term
| What are the two requirements that must be met to qualify for the Medicare hospice benefit? |
|
Definition
Certification must be signed by both certifying physician and the hospice medical director.
Must have a prognosis of terminally ill with six months or less to live if disease process takes it normal course. |
|
|
Term
| The primary standards used for licsensure and accrediation are... |
|
Definition
The hospice will licensed in the state it is in . It follows the Medicare Conditions of Participation.
Accreditation is optinal and is given by NHPCO /JACHO. JACHO publishs hospice standards on home care standards. |
|
|
Term
| Who serves as primary care giver in hospice? |
|
Definition
| The patients immediate family and or friends. |
|
|
Term
| The patient is in hospice for 6 weeks starting Feb 1st then learns about a new treatment , so he leaves hospice. After 6 weeks its obvious that the drug is not working , so the patient decides to return to hospice. Which benefit period will he enter? What is the admit date? What is the benefit start date? Are they the same date? |
|
Definition
| The patient will enter the subsequent benefit period from the first benefit period which he/she lost when they revoked hospice for other treatment. The benefit period the be the second 90 day period . The admit date is now March 15th and the new benefit period is the same date. |
|
|
Term
| What is "certification" and who must sign it? |
|
Definition
| Certification is a statement stating that the patient is terminally ill with 6 months or less and qualifies for hospice benefits under Medicare JPart A. It is signed both by the certifiying physician and the medical director of hospice. |
|
|
Term
| Your text gives a couple examples of the importance of interdisciplinary documentation describe one. |
|
Definition
| Volunteers are required to document all contact with the hospice patients , including telephone calls. The hospice volunteer coordinator is responisble for ensuring all volunteer visits are documented and that the volunteers are provided self address envelopes to mail documentation to the hospice office. |
|
|
Term
| Coding specificity is not required for reimbursement under hospice Why? Yet what reason does you text book give for coding as accuratley as possible -explain in your own words. |
|
Definition
| Coding is based on only the level of care and the benefit periods not on the patients diagnosis. Because coding for signs and symptoms helps to build a diagnosis database that can be used to evaluate not only the quality of care given but also the components to the care of various diagnosis groups like end stage diseases. |
|
|
Term
| Can a hospice patient be admitted for acute care and still remain in hospice? Explain. |
|
Definition
| Yes, if medically necessary as the primaray care giver can give 24 hour care or patient is recieveing tx such as dialyasis that requires acute care. The physician must certify that the patient is terminally ill and has life expectancy of 6 months or less. |
|
|
Term
| What is the reimbursement method for hospice? |
|
Definition
| Medicare part A and most commercial insurance companies reimburse hospice on a per diem or each day the patient is enrolled in a hospice program. The insurance company may only pay up to 180 days for hospice coverage or it can pay a designated dollar amount as a lifetime max for hospice services. |
|
|
Term
| Are hospice volunteers optinal or madatory? Per what regulations ? How is the percent of volunteer service caculated? |
|
Definition
| It is madatory per Medicare COP . 5% of the total patient care hours of all paid and contract staff. |
|
|
Term
| What is the Karnofsky scale ? What is it used for ? |
|
Definition
| The Karnofsky scale is a rating from 100-0 with 100 meaning no evidence of disease to 0 meaning death. It is used as a utilization tool hospice nurses as all hospice patients are expected to decline in severity of illness on admission it provides valuable related stats, so that one nurse will not always be assigned to the most severaly ill patients. |
|
|
Term
| Home health aids work independantly , so how is the quality of their services evaluated? |
|
Definition
| Many states have initiated testing for home health aides . The aide must demonstrate certain skills to become certified . Hospices hiring certified home health aides can at least be assured of a minimum skill level. |
|
|
Term
| What is the max % of inpatient days a hospice patient can recieve under Medicare? |
|
Definition
| 20 % of total patient care days. |
|
|
Term
| What is an "open record" ? |
|
Definition
| It is the patients record while in hospice the interdisciplinary team continues to add documentation to daily, weekly or at least every two weeks. |
|
|
Term
|
Definition
| A patient may revoke the election of hospice at any time. Upon revocation of Medicare hospice coverage , the patient resumes regular Medicare coverage and loses the remaining days within the election period. |
|
|
Term
| How often must a hospice nurse visit a hospice patient recieveing inpatient care? |
|
Definition
| At least once every two weeks same as if the patient were at home. |
|
|
Term
What is MSA and what role does it play in hospice?
|
|
Definition
| MSA or Metropolitan Statistical Area code is based on the geographical location of the patient . Claims are paid on the physical geographical location of the patient . These rates are published annually by the Center for Medicare and Medicaid |
|
|
Term
| Who bills Medicare for hospice inpatient care rendered at a contracted facility? Is there any direct patient billing associated with inpatient care? If so what -describe. |
|
Definition
| The contract stipulates that only hospice can bill Medicare (and other insurers ) for hospice care. The hospital or nursing home can charge the patient (or insurance company or even hospice) for room and board only. They cannot bill for the hospice services. |
|
|
