[silverwillow]

We have a patient that went out of service area and is now having symptoms and wanting to go to the hospital. Does he need to sign a revocation before he recieves care in the hospital? What do we do if he doesn't sign one?

[Wildbriar]

With our hospice, if someone leaves our service area they are no longer on our service and generally must be discharged and e-admitted when they return. It is either a discharge or a revocation depending on your state and company's policies. If we know someone will be leaving for a trip, etc. we do our best to coordinate a short-term admission to a local hospice if at all possible. We had one pt who wanted to go on a cruise with her family and cruise ships won't allow "hospice" pts on board (at least this line wouldn't) but we could d/c her, and confirm that DNR status would be honored by the ship's medical status, packed up her meds with her family and away she went.
-Erin

[river1951]

Yes, unless you wish to be liable for the hospital trip and I'm sure it's not your home hospital.
You could call a hospicw there to make a visit- I've done that if necessary and it can help, plus their medicaal director will usually order.
Anymore, we try to discharge if patients are going way out of our service area so they can get emergency care if they need it.
No easy answers on this one.

[EmptytheBoat]

Originally Posted by silverwillow

We have a patient that went out of service area and is now having symptoms and wanting to go to the hospital. Does he need to sign a revocation before he recieves care in the hospital? What do we do if he doesn't sign one?

The story is incomplete, but I will assume that you did not revoke/transfer when pt. went out of service area; yes, revoke, if he doesn't sign, then
discharge w/documentation retro. Best wishes!

[SCgirl1962]

We've been told that under Medicare guidelines, a revocation must be patient/ family driven. While I understand this on one level, it puts the hospice in a dilemma when patients don't really understand the concept of hospice and end up going to the hospital - not signing a revocation and we get stuck with the bill. Any ideas or comments?

[saribeth]

I never realized that pt/family had to revoke to be compliant with medicare...when a pt is no longer appropriate for hospice care we have them sign the revocation form...if a pt had to go to the ER for a feeding tube that fell out we would have them revoke but now our CEO feels we should cover it. I don't know how medicare expects us to give our pts what they need with the current per diem rate...we rarely break even! I know that we do give out pts the very best care possible...just venting...sure is good having you guys around...I get so much valuable info always thanks!

[andyg]

You can always discharge due to the patient seeking treatment at a hospice non-contracted facility. I am sure when you admitted them you explained which facilities you contract with. This covers you under the guidelines and you can readmit upon there return to your area. That way everyone gets what they need i.e. the patients gets the necessary treatment and hospice stays within guidelines and the hospital gets reimbursed as they should. Hope this makes sense. andyg