Medicare Emphasizes Patient Scores In Determining Hospice Appropriateness
Recently, Medicare has drawn attention to denial code 5CF36 – Patient is Not Hospice Appropriate. Hospice organizations face this error code when they have provided appropriate documentation that a patient is declining and appropriate for hospice. In fact, patient not appropriate for hospice was the second most common denial in Q1 of 2020 according to Palmetto GBA.
As hospices admit patients, document patient care, and submit patients for recertification Medicare is looking for a richer, more data-driven story to show that the patient is in decline. When hospices fail to appropriately show the patient's decline, it can result in survey deficiencies and unpaid claims that often are never recovered.
Despite advances in technology, many clinicians are still spending hours compiling charts from across disciplines and visits, creating recertification notes from memory, or missing the critical ESAS, LCD, and KPS scores that make it clear to Medicare that a patient is appropriate for hospice.
mumms Puts Patient Scores Front and Center
mumms has known the importance of including patient scores in telling the story patients decline for a long time. That is why we’ve included pre-populated LCD Forms, PPS, KPS, and ESAS scores front and center in every IDG meeting. This way, clinicians can include tangible scores in the patient narrative without digging through the entire patient chart to find these scores.
We’re not stopping at just showing the patients score at one moment in time. Because we’re consistently gathering these scores, clinicians can view patient scores over time to see the full picture of the patient's condition. This means clinicians can easily include the complete story at every IDG meeting when writing each patient narrative and during every recertification.