Hospice Program - PowerPoint PPT Presentation

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Hospice Program

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each MO HealthNet participant electing the hospice benefit; simultaneous election for those with dual Medicare/MO HealthNet coverage; and, ... – PowerPoint PPT presentation

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Title: Hospice Program


1
  • Hospice Program
  • Forms and Certifications

2
  • This training program will focus on the
  • required forms for the MO HealthNet
  • Hospice Program as well the required due
  • dates for each form. In addition,
  • information on initial certification and
  • recertifications will be provided.

3
Hospice Forms
  • Physician Certification of Terminal Illness
  • Hospice Election Statement
  • Hospice Nursing Facility Contract Update
  • Notification of Termination of Hospice Benefits

4
Hospice Forms cont.
  • Hospice forms can be obtained on the MO
  • HealthNet Division (MHD) Web site,
  • http//www.dss.mo.gov/mhd/providers/index.htm
  • All forms can be faxed to the Hospice Unit at
  • (573) 526-2041. Please do not mail forms
  • that have been faxed. Make certain all forms
  • sent, faxed or mailed, are legible.

5
Submission of Forms
  • It is the responsibility of the hospice to
  • submit all documentation in a timely manner.
  • Reimbursement of hospice claims is dependent
  • on receipt of correctly completed documentation.
  • If accurate documentation is not submitted to
  • MHD timely, hospice claims will deny. Late
  • submissions can cause denial of services to
  • participants, denial and/or incorrect payments
  • to providers.

6
Physician Certification of Terminal Illness
  • The hospice agency must obtain physician
  • certification an individual is terminally ill.
    The
  • Certification of Terminal Illness must include
  • statement the individuals medical prognosis is a
    life expectancy of six (6) months or less,
  • contain the physicians signature(s), and
  • be dated by the physician(s) within two (2)
  • calendar days after hospice care is initiated.

7
Physician Certification cont.
  • If the hospice does not obtain a
  • completed Physician Certification of
  • Terminal Illness within two days after the
  • initiation of hospice care, a verbal
  • certification may be obtained within
  • these two days and written certification
  • obtained at a later date.

8
The Hospice Election Statement
  • An election statement must be submitted for
  • each MO HealthNet participant electing the
    hospice benefit
  • simultaneous election for those with dual
    Medicare/MO HealthNet coverage and,
  • individuals receiving hospice services as a
    private pay client who later becomes
  • eligible for MO HealthNet.

9
Election Statement cont.
  • The participants hospice election date for
  • which services may be reimbursed by MHD
  • is no earlier than the first date of MO
  • HealthNet eligibility. The Hospice Election
  • Statement is due within five (5) days of
  • execution.

10
Recertifications
  • For each subsequent election period, the
  • hospice must obtain no later than two calendar
  • days, a signed and dated Physician Certification
  • of Terminal Illness. MHD follows Medicare
  • election periods of 90-90-60 days followed by
  • an unlimited number of 60-day periods. The
  • recertifications for these election periods are
  • due to MHD within five (5) days of the
  • recertification due date.

11
Hospice-Nursing Facility Contracts
  • The Hospice-Nursing Facility Contracts form
  • is used by the hospice to notify MHD of each
  • nursing facility the hospice has a contract
  • with. This form must be completed by the
  • hospice agency and submitted to the MHD
  • Hospice Unit before nursing home room and
  • board payments can be made to the hospice.

12
Hospice-NursingFacility Contracts cont.
  • The hospice and the nursing facility must
  • retain a copy of the contract a copy of the
  • contract is not to be sent to MHD. The
  • hospice must also have on file a copy of an
  • IM-62 form for each nursing home resident,
  • obtained either from the participant, the
  • participants family and/or representative or
  • the nursing home.

13
Notification of Termination of Hospice Benefits
  • The participant or participants representative
  • may revoke the hospice benefit at any time by
  • filing a Notification of Termination of Hospice
  • Benefits form. The effective date of the
  • revocation is the date of the participants or
  • participants representatives signature unless a
  • subsequent date is designated. A designated
  • effective date earlier than the date the
    revocation
  • is signed is unacceptable.

14
Notification of Termination of Hospice Benefits
cont.
  • The Notification of Termination of Hospice
  • Benefits form is due at MHD within five (5)
  • days for the following
  • Revocation by patient choice
  • Change of designated hospice provider
  • Decertification of terminal illness by
    physician
  • Discharge due to patient relocation or
  • Death of patient while on hospice service.

15
Reference Materials
  • Additional information regarding the MO
  • HealthNet Hospice Program can be found in
  • the hospice provider manual, section 13 located
  • on the MHD Web site
  • http//www.dss.mo.gov/mhd/providers/index.htm

16
  • Thank you for participating in this
  • training program. If you have
  • questions regarding the information
  • contained in this presentation,
  • please contact the Provider
  • Education Unit at 573-751-6683.
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