Home Care Analysis
Definition and Description of the Setting Hospice is a healthcare facility that provides care for the patients who are near the end of life and made a decision not to get treatments to prolong their lives. National Hospice and Palliative Care Organization (2016) defines a hospice focuses on “caring”, not “curing”, to concern the patient’s physical and mental support. Hospice care is provided in all kinds of settings: home, freestanding hospice centers, hospitals, nursing homes, and other long-term care facilities, however, a home care is most common among those settings. In home care, a family member serves as the care giver and receive supports from healthcare professionals. Physicians, nurses, social workers, and therapists stay in close
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(Statues 400.606) There are three accrediting agencies for Home care and Hospice;
• Accreditation Commission for Health Care, Inc.
• Community Health Accreditation Program
• Joint Commission on Accreditation of Healthcare Organizations
Coding Schemes Used The coding system related to hospice care, whether the patient is enrolled in the Medicare Hospice Benefit or not, almost always uses same mechanisms: CPT-4 and ICD-10-CM. There is a distinctive rule when coding for services rendered to Medicare hospice patients, which is easily missed or misunderstood and result in denial by Medicare; GW modifier is added to the services unrelated to the patient’s terminal illness, and GV modifier is used when the attending physician is not employed or paid under agreement by the patient’s hospice provider. (Hospice Modifiers)
Sample Policy and Procedure National Hospice and Palliative Care Organization created the compliance guide for hospice providers regarding to creating a clinical record (See Appendix C). The Sample Procedure was modeled by “Hospice Manual for Facility” by Mayo Clinic Health System (See Appendix D)
(Statues 400.606) There are three accrediting agencies for Home care and Hospice;
• Accreditation Commission for Health Care, Inc.
• Community Health Accreditation Program
• Joint Commission on Accreditation of Healthcare Organizations
Coding Schemes Used The coding system related to hospice care, whether the patient is enrolled in the Medicare Hospice Benefit or not, almost always uses same mechanisms: CPT-4 and ICD-10-CM. There is a distinctive rule when coding for services rendered to Medicare hospice patients, which is easily missed or misunderstood and result in denial by Medicare; GW modifier is added to the services unrelated to the patient’s terminal illness, and GV modifier is used when the attending physician is not employed or paid under agreement by the patient’s hospice provider. (Hospice Modifiers)
Sample Policy and Procedure National Hospice and Palliative Care Organization created the compliance guide for hospice providers regarding to creating a clinical record (See Appendix C). The Sample Procedure was modeled by “Hospice Manual for Facility” by Mayo Clinic Health System (See Appendix D)