December 2, 2015 | NHPCO
The hospice benefit is available only to individuals who are terminally ill; therefore, a hospice may discharge a patient if it discovers that the patient is not terminally ill. Discharge may also be necessary when the patient moves out of the service area of the hospice. The hospice notifies the Medicare contractor of the discharge so that hospice services and billings are terminated as of that date. In this situation, the patient loses the remaining days in the benefit period. However, there is no increase in cost to the beneficiary. General coverage under Medicare is reinstated at the time the patient revokes the benefit or is discharged.
Reasons for hospice discharge:
- The beneficiary decides to revoke the hospice benefit
- The beneficiary dies
- The patient moves out of the hospice’s service area or transfers to another hospice;
- The hospice determines that the patient is no longer terminally ill
- Discharge for cause: The hospice discharges the patient under a policy set by the hospice for the purpose of addressing discharge for cause, citing that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired. The hospice must do the following before it seeks to discharge a patient for cause:
- Advise the patient that a discharge for cause is being considered;
- Make a serious effort to resolve the problem(s) presented by the patient’s behavior or situation;
- Ascertain that the patient’s proposed discharge is not due to the patient’s use of necessary hospice services; and
- Document the problem(s) and efforts made to resolve the problem(s) and enter this documentation into its medical records.
The hospice must make every effort to resolve these problems satisfactorily before it considers discharge an option. All efforts by the hospice to resolve the problem(s) must be documented in detail in the patient’s clinical record and the hospice must notify the Medicare contractor and State Survey Agency of the circumstances surrounding the impending discharge.