Documenting Technical and Clinical Eligibility in Hospice

Documenting Technical and Clinical Eligibility in Hospice 

It is critical that hospices meet all technical and clinical requirements to comply with reimbursement guidelines. Non-compliance can result in significant payment penalties. In this course, you will learn about the technical requirements for payment related to: The Election of Benefits (EOB), Notice of Election (NOE), initial certification, recertification, physician narrative, and the face-to-face encounter visit. You will also learn about the clinical aspects of eligibility regarding prognosis and diagnosis and the relationship to Local Coverage Determination (LCD) Guidelines. Common problems related to documentation of eligibility and ways to prevent these problems will be reviewed.

$20.00

Hours: 1.00
REL-PAC-WB-DTCEH

Certificates

Certificates provided by accrediting body (11 Match)

California Board of Registered Nursing

1.0 HOURS


Provider approved by the California Board of Registered Nursing, CEP# 13791

Nurses will receive 1.00 contact hours for participating in this course.

District of Columbia Board of Nursing

1.0 HOURS


District of Columbia Board of Nursing Approved Continuing Education program (CEBroker Provider #50-290).


Nurses will receive 1.00 contact hours for participating in this course.

Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling

1.0 HOURS


Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling (CEBroker Provider #50-290).


This activity is approved for 1.00 contact hours.

Florida Board of Nursing

1.0 HOURS


Florida Board of Nursing (CEBroker Provider #50-290).


Nurses will receive 1.00 contact hours for participating in this course.

American Nurses Credentialing Center

1.0 HOURS


In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.



Association of Social Work Boards

1.0 HOURS


Relias, LLC, #1273, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Relias LLC maintains responsibility for this course. ACE provider approval period: 02/10/2018-02/10/2021.


Course Delivery Format: Asynchronous Distance Learning-interaction includes quizzes with questions and answers, post-tests.


This module is Reading-Based.


Social workers completing this course receive 1.00 Clinical continuing education clock hours.

New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Social Work Unit

1.0 HOURS


Relias, LLC is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0009.

Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of licensed master social work and licensed clinical social work in New York. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice for an LMSW and LCSW. A licensee who practices beyond the authorized scope of practice could be charged with unprofessional conduct under the Education Law and Regents Rules.

As a provider of online, asynchronous education, some courses offered by Relias Learning are considered “self-study” under section 74.10(c)(2)(ii)(b)(4) of the Commissioner’s Regulations. The regulations limit self-study activities taken from a provider approved by the Education Department to no more than 12 hours in the 36-month registration period or one-third of the hours in a registration period other than 36 months.

Social workers will receive 1.00 continuing education hours for participating in this course. This activity is approved for 1.00 contact hours.

Georgia Board of Nursing

1.0 HOURS


Georgia Board of Nursing (CEBroker Provider #50-290).


Nurses will receive 1.00 contact hours for participating in this course.

South Carolina Board of Nursing

1.0 HOURS


This program was approved by the South Carolina Board of Nursing Approved Continuing Education Program (CEBroker Provider #50-290).


Nurses will receive 1.00 contact hours for participating in this course.

West Virginia Board of Registered Nursing

1.0 HOURS


West Virginia Board of Registered Nursing (CEBroker Provider #50-290).


Nurses will receive 1.00 contact hours for participating in this course.

Ohio Social Worker Board

1.0 HOURS


Ohio Counselor, Social Worker and Marriage and Family Therapist Board
Provider #
CEBroker Provider: 50-290
This activity is approved for 1.00 contact hours.

Course Details

Course Code: REL-PAC-WB-DTCEH
Hours: 1
Type: Online Course
Content Expiration Date: 5/31/2021
Learning Objectives:
Describe the technical requirements for hospice eligibility.
Describe the clinical requirements for hospice eligibility.
Identify proper documentation practices to prevent payment issues related to technical and clinical eligibility.

Outline:

Section 1: Introduction

A.About This Course

B.Learning Objectives

Section 2: The Physician’s Role

A.Hospice Admission

B.Challenges

C.Summary

Section 3: Certification and Recertification

A.The Physician’s Narrative

B.Face-to-Face Encounter

C.Choice of Hospice Attending Physician

D.Review

E.Summary

Section 4: Election of Benefits

A.Elements of the Election of Benefits (EOB) Document

B.Navigating the Notice of Election Process

C.Review

D.Summary

Section 5: Communicating about Hospice Eligibility

A.What Information is Necessary?

B.Hospice Team Communication

C.The Medical Director Role

D.Review

E.Summary

Section 6: Clinical Applications

A.Scenario 1: Mrs. Gaither

B.Scenario 2: Mr. Ritter

C.Scenario 3: Mr. Dean

D.Review

E.Summary

Section 7: Conclusion

A.Summary

B.Course Contributor

C.References

D.Congratulations!


Staff Writer: Susan Heinzerling, RN, CHPN
Susan Heinzerling began her nursing career as a Med/Surg nurse. Renal patients in acute care, with multiple chronic conditions and repeated hospitalizations inspired her practice of hospice nursing where she began as Hospice Admissions Nurse and later became a Hospice RN Case Manager. Susan has practiced hospice nursing in both a large, urban area and in a rural setting. Susan earned a B.S. in Biology and B.S. in Nursing from the University of North Carolina at Chapel Hill and a Master's degree in Physiology from North Carolina State University. She became a Ph.D. Candidate in Immunology at the University of South Alabama. Her research experiences in the biomedical sciences led to an interest in evidence-based practices. Disclosure: Susan Heinzerling, RN, CHPN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Expert Reviewer: Carrie Cooley, RN, MSN
Carrie Cooley is the Principal / Chief Executive Officer (CEO) with Weatherbee Resources. Carrie joined Weatherbee in 2009 as an Associate Consultant and was hired as the Consulting Coordinator in 2012.  In 2014, Carrie was promoted to Director of the Consulting Division and in July 2015, she assumed the Chief Operating Officer position. Carrie was promoted to CEO in February 2018.  On July 1, 2018, Carrie and her business partner, Lynn Stange, purchased Weatherbee Resources from the company's founders, Heather Wilson and Joy Barry. Together, Lynn and Carrie plan to continue the long-standing history of Weatherbee Resources' service to the hospice industry.  In her role as Principal / CEO, Carrie ensures Weatherbee's consulting services, products, and education are provided in a professional and cost-effective manner and are specifically tailored to meet each client's individual needs. As one of Weatherbee's owners, Carrie is responsible for ensuring Weatherbee is positioned to assist hospices with the ever-changing regulatory hospice environment.  
 
Carrie's regulatory expertise and extensive consulting experience includes forensic clinical record auditing, baseline compliance audits/mock surveys, interim management, clinical due diligence, and executive coaching. Carrie and her team also work directly with clients' legal counsel in preparation for arbitration and other hearings; Carrie frequently serves as an expert witness. Weatherbee also works extensively with clients who are under a Corporate Integrity Agreement (CIA); Carrie and her team manage the Independent Review Organization (IRO) audit activities required by the Office of Inspector General (OIG). Carrie's excellent rapport with executives and staff alike – coupled with her regulatory and clinical acumen, and knowledge of best practices – assures excellent consulting outcomes.  
 
Under Carrie's leadership, Weatherbee has assisted hundreds of clients under investigation by various Medicare contractors including: Targeted Probe and Educate (TPE), Zone Program Integrity Contractors (ZPIC), Unified Program Integrity Contractors (UPIC), Benefit Integrity Support Centers (BISC), Recovery Auditors (RA), the Department of Justice (DOJ), and the OIG.   As a member of Weatherbee's Speaker's Bureau, Carrie teaches a broad range of hospice, regulatory, and leadership-related topics nationally and is a member of the faculty for Weatherbee's renowned Hospice Regulatory Boot Camps. Carrie also frequently speaks at state and national hospice conferences on compliance-related topics. Carrie is a registered nurse and holds a master's degree from Samford University with a specialty in nursing leadership and healthcare finance.

 

Disclosure: Carrie Cooley, RN, MSN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Instructor: Lynn Stange, RN, BSN, MA, CHC

Lynn Stange first joined the Weatherbee team as an Associate Consultant in 2006, and was promoted to Director of Consulting in 2007. Lynn re-joined Weatherbee in 2017 as the Chief Compliance & Consulting Integrity Officer and in February 2018, Lynn was promoted to President. In July 2018 Lynn, along with Carrie Cooley, Principal/CEO, purchased Weatherbee Resources, Inc. and Lynn assumed the title of Principal/President of Weatherbee Resources.

In her new role, Lynn is responsible for strategic growth initiatives in the areas of compliance, quality, and education. Lynn works with consulting clients in the areas of Quality Assurance Performance Improvement (QAPI), mock surveys and compliance audits, Joint Commission accreditation, State Licensure preparation, plans of correction, pursuit of the Malcolm Baldrige National Quality Award, hospice acquisitions/sales, and program development. Lynn will also oversee all aspects of Weatherbee's Hospice Compliance Network (HCN) and Weatherbee's product line. Lynn's breadth of experience with a variety of regulations and standards allows her to connect with clients quickly to aid them in identifying their most critical needs thereby assuring excellent outcomes. 

Lynn is a nationally recognized speaker in both the hospice and compliance arenas, having spoken at both the National Hospice and Palliative Care Organization (NHPCO) annual Management and Leadership Conference and at the annual Health Care Compliance Association (HCCA) national conference. Lynn is a member of the NHPCO Regulatory Committee since 2014. As a member of Weatherbee's Speaker's Bureau, Lynn teaches on a variety of regulatory, compliance, and leadership-related topics and is a permanent faculty member of Weatherbee's renowned Hospice Regulatory Boot Camp.

Lynn has been a registered nurse for 30 years with a Bachelor's degree in nursing from Carroll College in Helena, Montana and a Master's degree in Organizational Management from the University of Phoenix, Las Vegas. Lynn has been a State surveyor in both Montana and Nevada, and earned her Certification in Healthcare Compliance (CHC) in 2014.

Disclosure: Lynn Stange, RN, BSN, MA, CHC has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Instructor: Lauren Templeton, D.O.

Dr. Lauren Templeton, a Physician Consultant with Weatherbee Resources since 2017, has over 10 years of physician experience with 8 years specializing in hospice and palliative medicine.  Dr. Templeton began her career in internal medicine, but soon thereafter was drawn to end-of-life care due to its overall philosophy and her passion for ensuring a dignified death for her patients. 
Dr. Templeton currently works in hospice as the medical director for a medium size not-for-profit hospice based in Texas. In this role, she assists with compliance, quality improvement and documentation review. She continues to participate in clinical care managing hospice patients in both the home care and inpatient setting. 

Dr. Templeton also serves as associate medical director for the Palliative Care Department at a local medical center, as well as, serving on the ethics committee for the same facility. 

Dr. Templeton's mission is to help support hospices by educating on the role of the hospice medical director from a regulatory and clinical perspective. She continues a robust educational program within her own hospice program and is a speaker with the Texas New Mexico Hospice Organization. Dr. Templeton is an advocate of the hospice benefit and speaks to groups such as the Alzheimer's Association about hospice care. 

As a Physician Consultant with Weatherbee, Dr. Templeton assists hospice providers and physicians with:

  • Orientation for new medical directors and team physicians.
  • Education, coaching, and mentoring for hospice physicians.
  • Consulting on complex issues (e.g., making appropriate coverage determinations; ethical issues; challenging pain and symptom management cases; admission, recertification, and level of care eligibility; etc.).
  • Auditing physician and other clinical record documentation (e.g., thoroughness and appropriateness with regard to hospice eligibility; compliance with regulatory requirements; appropriateness with regard to coverage determinations; etc.).
  • Re-tooling the interdisciplinary group meeting and related processes.
  • Preparing physicians for Administrative Law Judge (ALJ) hearings.
  • Providing expert witness testimony in ALJ hearings and other legal matters involving patient eligibility.

Dr. Templeton graduated from Pennsylvania State University with a Bachelor of Arts and received her doctor of osteopathy from Ohio University College of Osteopathic Medicine in 2009. She completed a residency in Internal Medicine and is board certified with the American College of Osteopathic Internists. She completed a fellowship in Hospice and Palliative Medicine at Texas Tech University and became board certified in hospice and palliative medicine in 2013. Dr. Templeton became Hospice Medical Director Certified (HMDC) in 2018.

Disclosure: Lauren Templeton, D.O. has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Nurses; in the following settings: Hospice, Palliative Care.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Accommodations
If you require special accommodations to complete this module, please contact Relias Customer Support here.