Eli's Hospice Insider

1. Don't get sloppy. Your clinicians should document every case as if it will be audited, Noyce and Walling urged.

2. Get specific. Avoid vague terms like "slow decline" and "disease progressing," Noyce and Walling advised. Instead, CGS wants to see quantifiable values or measures, it says in a tool on its website, "Suggestions for Improved Documentation to Support Medicare Hospice Services." (For examples of such measures, see box on p. 4.)

3. Use LCDs. Use Local Coverage Determination criteria when you can in your documentation, suggested Provider Insights Inc. founder Annette Lee and Noyce in a separate presentation at the NAHC annual meeting, "Medical Review in the New Hospice Environment."

Tool: For a link to a PDF copy of CGS's LCD on terminal prognosis, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "Terminal Prognosis LCD" in the subject line.

4. Address improvements. Don't just ignore the occasions when your patient improves in an area rather than declining, Lee and Noyce recommended in their Oct. 2 session. Address anything that can be seen as an improvement.

For example: If your patient gains weight, explain in the documentation how hospice care has facilitated more caloric intake compared to pre-admission, Lee and Noyce said in the presentation. But then point out how far below a healthy weight the patient remains. And make note of things like "an appetite allowing only coffee and candy cannot be expected to restore this terminally ill patient to a well nourished state."

5. Don't limit yourself time-wise. It may drive you crazy when you get a non-terminal denial for a patient who has since died. Remember that an additional development request (ADR) may ask for records from a certain timeframe, but you are free to include more recent documentation that shows a later decline, Lee and Noyce offered.

Pointer: Put the date of death on the first page of an appeal, they advised.

6. Push education. Your clinicians won't magically become A+ documenters on their own. You'll need to use general education and individual coaching to get them where they should be, Noyce and Walling pointed out.

7. Check yourself. Use self-audits to find and correct problems before reviewers do, Noyce and Walling counseled. And you can use recert as a time to make sure the beneficiary still qualifies and your documentation still shows that.