Eli's Hospice Insider

Published on Wed Apr 28, 2010 PDF

Don't forget to recheck your patients for Medicare eligibility.

If you fail to get a properly timed election statement signed, Medicare can deny your patient's whole stay. Follow these steps to get your notices signed at the right time:

1. First things first. Before you begin furnishing Medicare-covered services, you should first assess the patient for hospice appropriateness and verify her Medicare eligibility, recommends Judy Adams with Chapel Hill, N.C.-based Adams Home Care Consulting.

"Providers are responsible for ensuring that they check a patient's Medicare eligibility upon admission," says regional home health intermediary Palmetto GBA in a question-and-answer set from a recent Ask The Contractor teleconference (ACT).

You must have two essential items in place before starting hospice care, Adams advises -- a "signature on a Medicare hospice election by the beneficiary or their designated agent and ... a verbal or signed certification of terminal illness by the physician." Don't proceed until these elements are in place, Adams counsels.

3. Educate your patients and their representatives. It is "particularly important to convey to beneficiaries or, more importantly, their authorized representatives," that you cannot initiate Medicare-covered services until they complete an election form, Adams says. They must be "aware services cannot begin until the election statement is signed and returned to the hospice."

4. Recheck eligibility. Checking patients' Medicare eligibility on admission isn't enough. You need to recheck it throughout their stay. Hospices must "check a patient's Medicare eligibility ... periodically throughout the time in which they are providing care," Palmetto instructs.

Checking a patient's status is key when the hospice knows the patient has applied for Medicare, Adams says. "Agencies need to continually check for eligibility."

5. Secure a signed election based on ETA. If you know your patient has applied for Medicare, you may have an estimated date when you expect her Medicare eligibility to kick in. If that's the case, you can have the patient sign an election statement based on that date, recommends consultant M. Aaron Little with BKD in Springfield, Mo.

For example: If you expect the patient to switch to Medicare on May 1, have them sign an election statement for that date, even if you don't yet have confirmation of the switch, Little advises. "Hopefully by the time the confirmation was received, the effective date would in fact have been May 1," Little says.

But be ready to take action if the switchover date isn't what you expect, Little says. In that case, "a new election would need to be signed as soon as possible and days prior to that date would not be payable by Medicare."