For healthcare providers, determining eligibility is a critical step to ensuring that a new referral is appropriately placed for the best course of care and that you will be reimbursed for the care provided. Hospices have used LCD’s for determining eligibility, but when it comes to palliative care, there isn’t a defined standard leaving many providers to create their own. And for those providers who offer both hospice and palliative care, it is especially important to get this piece right as there is a fine line between these care settings.
If a patient is referred and placed in hospice care, but later they determine they were not eligible, this results in lost revenue for the provider and potentially a disjointed patient experience.
The CMS has defined hospice eligibility as follows:
Patients with Medicare Part A can get hospice care benefits if they meet the following criteria:
- They get care from a Medicare-certified hospice
- Their attending physician (if they have one) and the hospice physician certifies them as terminally ill, with a medical prognosis of 6 months or less to live if the illness runs its normal course
- They sign an election statement to elect the hospice benefit and waive all rights to Medicare payments for the terminal illness and related conditions
Palliative care is provided to those living with a serious illness to improve quality of life and bring comfort by reducing the experience and intensity of symptoms and the stress of the illness. It is recommended by the physician at any time in the patient’s care journey and at state of illness regardless of if they have a terminal diagnosis.
For many providers who offer both hospice and palliative care, this process of determining eligibility includes a variety of system-based actions combined with capturing some data on paper and uploading it because the system doesn’t fully accommodate the issue at hand.
To solve this issue, Curantis Solutions has created a pre-evaluation document to best determine whether a referred patient should be on palliative care or hospice care. Once staff complete the pre-evaluation, they can confidently assign the referral to palliative care or hospice to begin the admission process.
The result is no lost revenue and a simplified process for staff that is entirely digital without any outside workarounds or paper processes needed. It is clearer for staff and eliminates process gaps or points of failure.
CURANTIS SOLUTIONS IS HERE FOR YOU.
As the demand for palliative care increases along with our aging population and increased numbers of cancer and chronic diseases, it will become imperative to streamline the intake process, asking the right questions and properly determining the best care path for patients.
We invite you to see for yourself how Curantis Solutions is improving operational workflows for hospice and palliative care organizations. Schedule a demo today!
Ready to schedule a demo, reach out here.
Reference Link: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice