Outline:
Section 1: Introduction

About This Course

Learning Objectives

Section 2: Foundations for Success

Hospice Business Success

The Referral: Insurance Eligibility and Verification

Medicare Payor Verification

Medicaid Payor Verification

Commercial Payor Verification

Communicating Verification Findings

Review

Summary

Section 3: From Hospice Referral to Hospice Admission

Medicare Hospice Admission and Billing

Notice of Election

Medicaid Hospice Admission

Commercial Insurance Hospice Admission

Billing Goals for Hospice Admission

Review

Summary

Section 4: Be Proactive

Tools to Facilitate Effective Revenue Cycles

Certification of Terminal Illness

Benefit Periods and Face-to-Face Encounter

Choice of Attending Physician

Plan of Care

Appropriate Use of the Levels of Care

Evaluate Ongoing Hospice Clinical Eligibility

Service Intensity Add-Ons

Revocations and Live Discharges

Deaths

Transfers

Hospice Patients as Residents of Nursing Facilities

Review

Summary

Section 5: Hospice Service Structure and Coding

Levels of care

Service Intensity Add on Payments

Revocations and Live Discharges

Transfers

Deaths

Hospice Patients as Residents in Nursing Facilities

Residential Patients in Hospice Facilities

Review

Summary

Section 6: The Hospice’s Financial Health

Successful Billing Processes Bring Revenue

Successful Billing: Minimize AR Aging

Medical Expenses for the Hospice Patient

Hospice Supplemental Income

Review

Summary

Section 7: Conclusion

Summary

Course Contributors

Resources

References

Hilda Kee has had well-rounded experience in the financial aspect of the healthcare industry.   Hilda's entire career path has allowed her the opportunity to assist with monitoring, management and development of organizational processes of the business operations related to medical care.  She has worked for insurance companies, hospital and other medical facilities, revenue cycle management companies and now hospice. This has given Hilda the opportunity to become well-versed in insurance benefit language at different levels of the industry, including the claims review process, and creation and compliance of contract terms between providers and insurance to accomplish revenue cycle management expectations. Disclosure: Hilda Kee, BA Organizational Management has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.

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.