Hospice Charting and Recertifications - page 2

I am new to Hospice and our Palliative doctor will be giving an inservice on "Hanging the crepe" to assist us RN's in charting for the hard recertification. I was wondering if there were any other suggestions out there? Thanks... Read More

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    Example of charting to decline.
    Mrs. Smith has:
    -Needed increased x to manage symptom y
    -Had a x cm mid arm circumference loss and a x number of pound weight loss
    -needed increased assistance with x number of adls
    -has had a decline in her karnofsky score from x% to y%

    In a pt who is declining, but in a not easy to chart kind of way, we will often pull back hospice services. So often hospice pts are only doing well because of the support they are getting, but often in only 1 or 2 weeks with no aide services and only 1 every other week nursing visit we will see bedsores, falls, increased confusion, appetite changes. It is incredible, and makes it easy to recert someone.
    Hospice Nurse LPN likes this.
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    LCD= Local Coverage Determinations. These are the criteria guidelines for specific hospice admission criteria based on the patient's diagnosis. You can find these on the CMS website but, your company should have a worksheet also that has the criteria. Hope this helps.

    Here is the link:

    Last edit by CANRN on Sep 26, '11
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    LCD stands for "Local Coverage Determination". They are the guidelines we use to qualify or disqualify a patient for hospice services. If the patient does not meet the required LCDs they should not be admitted or recertified for hospice care.

    As a new hospice nurse you need to become very familiar with the LCDs for the different dx's and pathologies. When you document you measure your assessments against those guidelines and try to include the data that supports (or not) them. So for instance, watch weight and ADLs with functional performance closely in all patients but particularly those with dx such as dementia or debility. If you are not able to weigh patients measure their arm circumference & note the observance of signs of wasting. Make sure you are documenting any increase in use of the prn palliative meds and all symptom changes. If you are charting evidence of decline in the patient we should normally see an increase in use of services by the patient and family in the record. For example, increased prn or after hour visits or calls, increased routine nursing (including HHA) visits, and/or increased MSW or pastoral visits generally coincide with declines in the health and functional status of the patient and this documentation in the POC and notes will help you to recert your patients...or decide to dc them.

    Keep in mind that Medicare will not pay for hospice to keep a patient on service simply to complete the dc planning. If the patient is no longer appropriate they (MCR) expect hospice to dc post haste, assuming that the hospice team has begun that planning the moment they have begun to question eligibility of the patient. Some hospices are now considering including discharge planning as part of the basic POC for all admits.

    The process of Certification and Recertification can be tricky but it is always best to err on the side of caution as missteps can cost the hospice agency lots and lots of money.

    Good luck!
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    Local Coverage Determinators

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