Revoking and Hospitalization

[Kabin]

What's the norm for home hospice pt's going to the hospital for something related to the terminal diagnosis? It seems complicated. Sometimes it's unfair for the hospice agency to cover hospitalization costs and other times it borders on being unfair to the taxpayer.

What does you company do when a terminally diagnosed COPD pt decides to go to the hospital for COPD exacerbation?

I've seen cases were the MPOA/pt signs the revocation form that day and other times wait until the hospitalization is over and then have MPOA/pt sign the revoke form with a back date prior to the hospital admit date. What's acceptable?

Are there online US government guidelines for these scenarios?

[Kabin]

Thanks, that's good input.

The other thing is the interpretation of 'aggressive treatment.' It can be twisted to suit the hospice agency's purse strings. For better or worse, there's just not enough auditors out there to catch everything.

[toomuchbaloney]

Aggressive treatment is generally defined as treatment outside of the POC which is not palliative in nature or involves goals of care which are not palliative.

[cpbeckCHPN]

The hospice has the choice of either paying the hospital bill or asking the patient to revoke. There are times with small hospitalization bills that we do not revoke. Or, if the patient is charity care funds we do not revoke, but then we expect the hospital to use their charity care funds to cover the bill.

No no no no no no no no no!!! Ask a patient to revoke?! Are you serious? I may look like I'm typing dramatic, but it's because I am! No wonder hospice has a crummy reputation. A hospice cannot revoke! To ask a patient to revoke is coercion... possibly criminal in nature. You do not, as a hospice, have the ability revoke! You can discharge, but with the consensus of the IDT, and documentation of the stability / lack of declination of the patient, thus lack of "terminal' illness, which is why a hospice should be very very selective in the hiring of people that make these decisions. Having the majority of your census on debility / failure to thrive is a hint that you shouldn't be working for them. That stinks of money-grab.

[cpbeckCHPN]

BACKDATING a revocation form is MEDICARE FRAUD

Hugs, NC29mom! Backdating anything, anywhere in life, is at best a red flag. At worst, an intentional deception.

[jeannepaul, BSN]

You can fill out the revocation paperwork on a different date. There is a line that says revocation effective.... And you insert that date, however when signed, the date is when the form is filled out. On occ. we have had pt go without informing us, so when we find out, we have done it that way, it is not backdating unless you use an earlier date that the family signed as though you filled it out earlier.

[toomuchbaloney]

You can fill out the revocation paperwork on a different date. There is a line that says revocation effective.... And you insert that date, however when signed, the date is when the form is filled out. On occ. we have had pt go without informing us, so when we find out, we have done it that way, it is not backdating unless you use an earlier date that the family signed as though you filled it out earlier.

This is an interesting nuance.

It is perfectly acceptable for a patient to notify their hospice provider that they are planning to revoke their hospice benefit on a day occurring in the future and to sign the appropriate paperwork in advance.

[areensee]

This is an area that has costs hospice agencies a lot of money. It is extremely important to know if the hospitalization is related to the diagnosis or not. It is also important to communicate with the hospital staff so that they know the patient is a hospice patient. Sometimes it is unclear whether it is related or not. In any case, it is the administrator's responsibility to make the decision regarding whether to revoke the patient or not.

[areensee]

I disagree about the use of the revocation paperwork having the patient sign on a date, but listing the effective date as an earlier date. Clearly, a benefit can not be revoked BEFORE the date the paper is signed. The line which asks for effective date is to be used in the case that a patient knows they are going to revoke in the future, say for example the patient has decided to schedule a surgical procedure which is related to the diagnosis. It is not retroactive. Using the form as such may jeopardize your agency's billing.

[NC29mom, ASN, LPN, RN]

This is an area that has costs hospice agencies a lot of money. It is extremely important to know if the hospitalization is related to the diagnosis or not. It is also important to communicate with the hospital staff so that they know the patient is a hospice patient. Sometimes it is unclear whether it is related or not. In any case, it is the administrator's responsibility to make the decision regarding whether to revoke the patient or not.

Its NEVER EVER EVER your" "Administrators responsibility to make the decision regarding whether to revoke the patient or not".......PLEASE PLEASE know...revocation is PATIENT GENERATED. A hospice CANNOT decide for a patient to revocate. Now, a hospice can initiate a DISCHARGE. There is a very distinct difference.

If a patient enters the hospital for a related condition, but the hospice feels the treatment is aggressive in nature, or not on the plan of care, it's in the patients best interest to revocate, but we don't ask or tell them to. If they choose NOT to revocate, an ABN form should be filled out indicating the pt will likely be responsible for the costs associated with the hospitalization. Unless there's an unmanaged symptom related to the terminal dx, hospice can only bill at the routine home care rate.

I agree......signing a revocation form stating the patient revocated several days ago (which just happened to be the same day the pt went to the hospital) and then having the patient sign and date for today is suspicious (and fraudulent in my opinion) at the very least. thankfully my employer doesn't practice in that manner. the day the revocation form is signed is the day the revocation is effective.

[toomuchbaloney]

This is an area that has costs hospice agencies a lot of money. It is extremely important to know if the hospitalization is related to the diagnosis or not. It is also important to communicate with the hospital staff so that they know the patient is a hospice patient. Sometimes it is unclear whether it is related or not. In any case, it is the administrator's responsibility to make the decision regarding whether to revoke the patient or not.

The administrator cannot revoke the patient.

The patient may decide to revoke, the hospice may not coerce the patient into revoking.

The hospice administrator may discharge the patient.