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Medicare’s Keys to Documenting a Six-Month Prognosis: LCDs

presented by Annette Lee, RN, MS, HCS-D, COS-C

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Disclosure Statement:

Financial: Annette Lee receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Nonfinancial: Annette Lee has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 53 Minutes; Learning Assessment Time: 33 Minutes

No one has a crystal ball, so how do we know when patients are ready for hospice? There are specific tools each Medicare Administrative Contractor has gathered that have been shown to be useful in prognostication. These tools assist all hospice team members in understanding prognosis and provide both a foundation for key decision-making moments and an outline for our documentation.

Meet Your Instructor

Annette Lee, RN, MS, HCS-D, COS-C

Annette is a registered nurse who has been practicing since 1990, with the majority of her nursing experience being in public health care. She has a master's degree in health care administration. In 2000 she joined the home health intermediary Cahaba GBA, where she became an instructor, providing education to home health and hospice providers…

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Chapters & Learning Objectives

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1. What Is a Local Coverage Determination (LCD)?

In this chapter, we will discuss the three Medicare Administrative Contractors (MACs) that oversee hospice payment for Medicare providers and explain the history of the local coverage determinations (LCDs) developed by the MACs. We will learn how the MACs use the LCDs for audits of hospices across the country.

2. The Unipolicy of NGS and CGS

This chapter will identify the components of the CGS/NGS “Unipolicy” Hospice LCD, including the the LCD’s introduction, which discusses documentation, plateau, and overall intended use for the guidelines. We will investigate the “decline” policy, or “Part 1,” describing the patient’s decline as a predictor of six-month prognosis, and how these decline factors are listed, with most predictive at the top of the list and least predictive at the bottom.

3. Disease-Specific Guidelines (NGS/CGS)

This chapter will identify the specific indicators in the Unipolicy for cancer and noncancer diagnoses used as guidelines for a six-month prognosis. This includes disease processes like dementia, heart disease, and respiratory illnesses, for which it is more difficult to show a terminal prognosis.

4. Palmetto LCDs

This chapter identifies the specific Palmetto LCDs and how they differ from the Unipolicy of the other MACs. It is important to note that Palmetto also uses the International Classification of Functioning (ICF) model to show support for terminal decline in any illness. This chapter will introduce us to the ICF guidelines.

5. Using the LCD: From Admission to Discharge

This final chapter will utilize your knowledge of the LCDs and describe how they can be used throughout hospice operations to build a culture of compliance, from admission to recertification to discharge.

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