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Hospice & Palliative Care Handbook, Fourth Edition

Quality, Compliance, and Reimbursement

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The goal of the fourth edition of this book is to help hospice clinicians, team members, and managers meet numerous quality, coverage, and reimbursement standards and requirements for success in daily practice, operations, and documentation. All these components are needed to meet the coverage requirements of the Medicare Hospice Benefit and provide skillful and compassionate hospice care. Part 1-Hospice Care: An Overview of Quality and Compassionate Care. This part provides the foundational information needed to understand hospice and hospice within the confines of the larger healthcare system. Simply put, hospice, a type of palliative care, is the model for quality, compassionate care for people facing a life-limiting illness or injury. This model and special care is explained in this opening part. Part 2-Documentation: An Important Driver for Care and Coverage. This part focuses on the numerous and important roles that documentation plays in the provision of care as well as quality and reimbursement components related to hospice care. This part provides the fundamentals as well as why documentation is the key to care coverage, compliance, and quality for hospice patients and organizations. Part 3-Planning, Managing, and Coordinating Hospice Care. Hospice care is individualized care provided by the interdisciplinary group for each patient and the patient's family. This part clearly explains hospice care planning and the ongoing process for success. Part 4-Hospice Diagnoses and Guidelines for Care. Prior parts of this book address that the Medicare Hospice Benefit is prognosis-based, which means that the patient must have a limited life expectancy and the hospice is responsible for caring for and covering all costs for the terminal or primary diagnosis and all diagnoses that contribute to the terminal prognosis. In this part, the guidelines for care or care problems are specific topics or diagnoses that are organized alphabetically for easy identification and retrieval of needed information. This information can then be individualized for your hospice patient/family and used throughout care and care planning as well as in the clinical record. This information can even serve as a basis for a common glossary in team meetings, discussions, and ongoing care planning communications. This part was formatted and designed for easy review for care and care planning and related activities. The hospice diagnoses or care guidelines are generally formatted in the same manner across all sections/diagnoses topics, as follows:General Considerations Eligibility Considerations Potential Diagnoses ICD-10-CM Diagnostic Coding Safety Considerations Skills and Services Identified Patient, Family, and Caregiver Educational Needs Tips for Supporting Quality, Safety, Eligibility, and Reimbursement Quality Metrics

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Tina M. Marrelli, MSN, MA, RN, FAANTina Marrelli is the author of numerous books, including Home Care Nursing: Surviving in an Ever-Changing Care Environment, her book directed toward caregivers, a sometimes undervalued person on the healthcare team; A Guide for Caregiving: What's Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself!; Handbook of Home Health Standards: Quality, Documentation and Reimbursement (2018); and The Nurse Manager's Survival Guide.Tina has a long-term relationship with hospice and hospice colleagues. Medicare did not recognize hospices or pay for hospice care until 1982. In the early years of hospice, both the staff at CMS and the leaders of the early hospices worked to make sense of the law and the population it served, working together to develop the kind of hospice care that is now identified with the name. She was an early participant and remembers those heady days. For the more "experienced" readers, you might recall Tom Hoyer of HCFA (now CMS) fame. Tom was termed the "hospice czar" and was a driving force for positive change. This means that at that time, hospice was primarily volunteer. It was pretty much grassroots and mission-driven to try to change and improve end-of-life care for patients and to support their loved ones. This all sounds common sense now, but looking back, it was not. At that time, Tina was the Director of a systems-based nonprofit Home Care and Hospice in Annapolis, Mary- land (USA), and it was the first hospice to receive TJC accreditation. So she has always embraced the hospice philosophy and model and (still) wonders why the rest of the healthcare system does not also embrace family and friend caregivers.Tina attended Duke University School of Nursing, where she received her undergraduate degree in nursing. She also has a master's degree in health administration and in nursing. Tina has worked in hospitals, nursing homes, and public health. She has practiced as a visiting nurse and man- aged in-home care and hospice for many years.Tina is the Chief Clinical Officer for Innovative Caregiving Solutions, LLC, an innovative e-caregiving technology (www.e-caregiving.com). Finally, caregiving and caregivers (loved ones, friends, partners, and others) are being recognized for their important contributions, knowl- edge, and roles. She is an international healthcare consultant, specializing in home care, hospice, and community-based models of care. Tina and her team of specialized consultants have been practicing in the home care and hospice environments for more than 20 years. Tina is a founding member of the International Home Care Nurses Organization (www.IHCNO.org), which was developed "to support a vibrant worldwide network of nurses to promote excellence in providing opti- mal care to patients living at home wherever they live in the world." The IHCNO was started with a small but "mighty" group of nursing leaders. She has been the editor of three peer-reviewed publications-most recently for Home Healthcare Nurse (now Home Healthcare Now), and she is an Editor Emeritus. Tina also serves on the editorial boards of the Journal of Community Health Nursing and The American Nurse.