Quick links to:

• Guidelines for Determining the Top 10 Terminal Diagnoses
• Hospice Certification Form
• Physician Payment Guide

CMS TO PHYSICIANS:

“Don’t fear to certify terminally ill.” CMS (formerly known as HCFA) has issued the following statement:

The Medicare program recognizes that terminal illnesses do not have entirely predictable courses, therefore, the (Hospice) benefit is available for extended periods of time beyond six months provided that proper certification is made at the start of each coverage period. Recognizing that prognosis can be uncertain and may change, Medicare’s benefit is not limited in terms of time. Hospice care is available as long as the patient’s prognosis meets the law’s six-month test. This (six month) test is a general one. As the governing statute says: “The certification of terminal illness of an individual who elects Hospice shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness.” The statute further notes that, “making medical prognostication of life expectancy is not always exact.” Thus, there is no reason for a physician to be concerned about certifying an individual for Hospice care that he or she believes to be terminally ill. The best question to ask yourself is, “Would I be surprised by this patient's death within the next year?”

Early referral greatly enhances the effectiveness of the Hospice team by providing ample time to address both the physical needs of the patient and the practical, emotional and spiritual needs of the entire family. Consistently we often hear the comment: “I wish we had known about Hospice much sooner.”

To facilitate transfer to Hospice, our patient care coordinators and admissions team work closely with the referring physician and staff. We are also available to meet with patients and families about Hospice services.

To enhance continuity of care, we encourage physicians to oversee their patient's Hospice care. The attending physician is eligible for Medicare reimbursement related to care plan oversight and bills for services as usual, develops the plan of care and approves updates, attends Hospice team meetings if desired, and may request the Hospice medical director to offer professional consultation. Only the attending physician and Hospice may bill Medicare for services relating to the terminal illness.

Once a patient is admitted to Hospice, one of the Hospice Medical Directors, fully licensed physicians specially trained in end-of-life and pain management care, can coordinate with the referring physician as desired to determine the most effective pain and symptom management program.

The guidelines below are designed to help you make determinations and speed the process both for admission and efficiency.

1. Alzheimer’s Disease
2. Cancer
3. Decline in Clinical Status
4. Heart Disease
5. HIV
6. Liver Disease
7. Neurological (ALS, MS, Huntington’s, Parkinson’s)
8. Pulmonary Disease
9. Renal
10. Stroke, Coma

Download Hospice Certification Form
Please sign and fax to 352.873-7445 or call 352-873-7415