Hospice Continuous Home Care: How Well Are You Documenting It?
What is continuous home care?
- Continuous home care includes services rendered only during a period of crisis and only as necessary to maintain the terminally ill individual at home.
- Continuous home care is not automatically covered for 'active dying'. There must be a clinical need for services and the need for those services should be evident in the documentation.
What is a crisis?
- A period of crisis is a period in which the individual requires continuous care to achieve palliation or management of acute medical symptoms.
- Nursing care in the hospice setting can include skilled observation and monitoring when necessary and skilled care needed to control pain and other symptoms.
What are the requirements for continuous home care?
- The hospice must provide a minimum of eight hours of care during a 24-hour day, which begins and ends at midnight.
- The care must be predominately nursing care provided by either a registered nurse or a licensed practical nurse.
- At least half of the hours must be provided by registered nurse or a licensed practical nurse. Hospice aide services may be provided to supplement the nursing care.
- Documentation of care, modification of the plan of care and supervision of aides does not qualify as direct care.
What is needed to document continuous home care?
- The crisis requiring the use of continuous home care needs to be clearly documented.
- Provide the date and time the interventions were performed. Include the title of the care giver (registered nurse, licensed practical nurse, or hospice aide).
- A log or a sign in sheet that includes the actual times, name and title of the health care provider rendering care is beneficial for accounting for the continuous home care hours billed.
- If the level of care changes the plan of care should be updated to reflect the change in condition.
- When responding to an Additional Development Request (ADR), submit all documentation to cover all of the continuous home care hours billed.
- If the documentation submitted for review supports the terminal prognosis, but does not provide evidence that continuous care services were reasonable and necessary, the claim may be reduced to the routine home care rate.
References
- CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 11, Section 30.1.
- Code of Federal Regulations, 42 CFR - Section 418.204 (a)
- CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 9, Section 40.2.1.
Revised July 2, 2009