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Should Patient be Revoked???

Hospice   (7,833 Views 16 Comments)
by AtlantaRN AtlantaRN, RN (Member)

AtlantaRN has 13 years experience as a RN.

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Im at a loss for this one. Alzheimers patient, still ambulatory, but declining intake. Started on Bactrim 3 days ago for foul urine and scant output...

Saw him today at 9am, stayed til 9:30...encouraged spouse to hydrate with water and cranberry juice, really push the water.....I get a call from my office at noon "they have called 911..." Family said "he passed out, and we got scared...he isn't acting right."

Corporate is telling me to revoke this patient, he is still in the ED. If we didn't authorize the ED visit, I don't think we have to pay for it. ((((Dollars to donuts, i'm certain it's the UTI)))).....

Opinions??? Advice...

Thanks!

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10,851 Visitors; 932 Posts

You cannot revoke a patient. Only a patient can revoke their hospice benefit. You can encourage the family revoke so that they will not have charges for the ER visit which was outside their plan of care since they did not call before going and discuss this with you. They must sign the revocation today. Revocations cannot be post-dated.

A hospice can only DISCHARGE a patient for 3 reasons:

Patient leaves the service area

Stabilized and no longer considered terminal

Unsafe to provide care (only after all measures taken to find a safe way)

I recently participated in an NHPCO audio seminar regarding revocation and discharge and these were some of the points that were highlighted. These are from the Medicare Conditions of Participation (affectionately known as the COPS)

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AtlantaRN has 13 years experience as a RN.

10,372 Visitors; 763 Posts

Thank you for your input. I spoke with the daughters at the hospital, the mom, who is POA was not present... I'm still not able to get POA on the phone and she is not at the hospital with the patient.

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babynurselsa has 12 years experience and specializes in ER, NICU, NSY and some other stuff.

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But as long as ER dx is not the same as the Hospice Dx medicare should still pay right????

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AtlantaRN has 13 years experience as a RN.

10,372 Visitors; 763 Posts

"But as long as ER dx is not the same as the Hospice Dx medicare should still pay right????"

I would think so. I had another patient to have cataract surgery, she didn't mention it until after the fact, and believe you me, i would have HEARD if she would have gotten a bill for it.

The question is, if this patient was admitted, do I discharge them until they are out of the hospital and resume services upon discharge?

thanks!

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10,851 Visitors; 932 Posts

But as long as ER dx is not the same as the Hospice Dx medicare should still pay right????

Well....hopefully it will float right through, but there are a lot of things Medicare just automatically rejects and you have to put through a second time with additional documentation to get them paid. This might be one of those things that was not medically necessary for ER treatment so it might prompt a rejection. And particularly so if under audit by CMS.

Atlanta, do you have a GIP contract with the hospital? If so you could keep her on service during her stay...but then hospice is supposed to run the show with her care plan and make a daily visit.

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AtlantaRN has 13 years experience as a RN.

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nope, no contract with the hospital. The MD that saw the pt today was furious that the patient was admitted (stated he was stable and should have went home from the ED yesterday---apparently 5 of his patients that he rounded on shouldn't have been admitted).

When family found out that he was to be discharged home, they demanded inpatient hospice, or short term nursing home placement so mom can get a "rest". Now, this patient was just in respite until the middle of this month...He is still ambulatory, declining, but ambulatory, and wife has a sitter come in 8h a day, every day. In essence, they want assisted living, but they don't want to pay for it.

Wife did sign the revoke this morning when I explained that she would have a bill for the ED visit.....I did encourage her that our services would resume once the patient was discharged home.

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AtlantaRN has 13 years experience as a RN.

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UPDATE: I get a call from my hospice stating a competitor has been up at the hospital evaluating the patient for inpatient placement. At the same time I get a call from our marketer saying "you had better get up to that hospital and find out what is up with your patient." .......OK, FIRST OF ALL, I was up there at 7am-7:45, at 11am-11:30 getting the revoke from the wife/poa, spoke with case manager at 12:46-1pm........

Hospital nurse says a GI doc is putting in a peg tube in the am, and he is going to an inpatient facility for inpatient hospice.

Why isn't he coming back to us? We contract with a NH that the family refused to place him at for respite....and the other place we contract with charges $5 less than the perdiem per day we collect....

I am just so ANGRY that the marketer would be so ugly with me. Truth be told, this afternoon from 1p-3:30p I was out doing HER JOB, marketing.

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

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Wonder if the family is aware of copay for inpatient stay not medically necessary.

Sounds like family not clearly hearing your hospice message and family thinks wife can't handle pt at home.....little further education might have altered this situation IF they were ready to HEAR what was being said.

Denial can be very powerful....also way to get one's way.

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3,452 Visitors; 474 Posts

The pt would only have to pay a co-pay if they don't meet criteria. The other hospice might be using some creative documentation to get the patient in to their IPF - or they may decide it's worth it for them to lose money in order to steal a patient from another hospice. If I were this family, I would much rather be in a hospice in-patient facility than a nursing facility.

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RNorBust has 17 years experience and specializes in pedi-onc, Adult Acute care, LTC, more.

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IF you dischard the patient while they are in the hospital, they will have to be a complete new admission to resume services. Wheather the hospice gave consent for the ER visit or not, most of the time, RHC will be paid as any other medical bill incurred by a medicare/caid recipient. IF it is determined by your medical director that the pt is being treated for a UTI secondary to the dementia.. then it would be a GIP paid by the hospice provider at a per diem rate (usually about 500/day) provided that the patient is at a contract facility.

If the patient is ambulatory, he probably should not be on service for dementia, he would need substantial comorbids documented in order for him to meet admission criteria. For Dementia he should have a fast of 6e and lower I belive along with a pps of 40 or less. the fast and pps may actually be lower, I don't have my flip chart in front of me. Anyway, Like the others have stated before me, only the patient/pcg can revoke. That is a statement from them removing themselves from service. If they revoke or if the company finds a way to d/c him from service, he will have to meet admission elegibility to go back on sevice.

Does any of this help you?

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wonderbee is a BSN, RN and specializes in critical care; community health; psych.

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Our medical director wants us to summarily revoke hospice when patients are admitted. He feels we are essentially pretty useless since the hospital is running the show. We readmit them to hospice when they get discharged from hospital.

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