Avoid Denial of Claims With Proper Documentation: New Education Series on the Medicare Hospice Certification Requirement
The top reason Medicare denies hospice claims centers on improper documentation, which is projected to result in $2.9 billion in improper payments. In this new series, we’ll share information, tips, videos, and continuing medical education trainings to help reduce claim denials. Starting with proper certification of terminal illness (CTI) is critical.
When is CTI needed?
For patients to receive hospice coverage under Medicare, providers must submit CTI documentation at these intervals:
• Benefit period 1: the first 90 days
• Benefit period 2: the next 90 days
• Benefit periods 3+: each subsequent 60-day period
What should be included in the CTI?
• Statement of terminal illness: simple statement that the patient’s life expectancy is 6 months or less (≤ 6) if the terminal illness runs its normal course
• Clinical findings that support terminal illness: specific clinical findings (e.g., patient diagnosis and prognosis, laboratory results, rapid decline in patient status) to support a life expectancy of ≤ 6 months
• Hospice benefit period(s): specific “from” and “through” dates (i.e., MM/DD/YY to MM/DD/YY) for each period of hospice care
• Narrative: synthesis of the patient’s individual clinical circumstances that support a life expectancy of ≤ 6 months and a statement attesting that the physician wrote the narrative based on their review of the patient’s medical record or an examination
• Physician signature and date: legible physician signature and date (e.g., Chris Smith MD, MM/DD/YY) directly below the narrative; if illegible, type or print the name below the signature.
• Face-to-face encounter and attestation: face-to-face visit by a hospice physician or hospice nurse practitioner
Click to review full ‘Physician Certification’ resource sheet. |
