SNF’s may want to review their residents receiving
hospice services to identify those with non-cancer diagnoses and ensure the
medical records contain sufficient documentation to demonstrate the illness is
terminal and progressing in a manner that a physician would reasonably have
concluded that the beneficiary’s life expectancy is six months or less.
Documentation is especially important for residents that remain on the hospice
benefit for an extended length of time in order to demonstrate why hospice
services are appropriate.
Providers who receive an Additional Documentation Request (ADR)
must submit the requested medical record information within 30 days to
Palmetto. When the claim is finalized, the claim will have paid in full
or part, or denied. If you disagree with the decision, you may request a
redetermination within 120 days of the determination (date on the remittance
advice). Completed review results will be posted to the Palmetto GBA website.
A SNF’s corporate compliance officer may want to designate a team
to evaluate whether or not this hospice issue applies to them and if so,
designate resources to proactively assess the situation. Please contact
any Krieg DeVault health care attorney to assist you with any questions you
might have.
A copy of the notice can be found here.
For questions, please contact Lori
McLaughlin lmclaughlin@kdlegal.com.