Medical necessity in the hospice realm

[sherivickery]

As a nurse auditor, I'm often presented with cases & claims for dates of service where it's pretty obvious that a recipient doesn't qualify for hospice services based on medical necessity. What we're having difficulty with is rephrasing that terminology so it can be adequately defended if we go to hearing.

Does any one have any suggestions?

Thanks.

 

[mitchellde]

If the patient did not have the medical necessity to be in Hospice care, then there is really not any other way to say that is there? How is it that they were able to be in Hospice if there was no medical necessity for it in the first place?