Hospice billing for general inpatient care (GIP) continues to attract the attention of CMS and other regulators who are concerned with whether hospices are correctly providing GIP services. One of several levels of care provided to hospice patients, GIP services are required when a patient needs more than basic care, and it generally involves more clinical attention and pain management. GIP was conceived as a short-term portion of the hospice benefit to serve patients with various symptoms/conditions that cannot be adequately addressed in the home setting and that necessitate moving the patient to an inpatient setting until the urgent needs are satisfactorily addressed and the patient is safe to return to the home/community setting with routine home care.
As the number of hospice-operated inpatient units rises, and the characteristics of the hospice patient population changes, regulators have become more and more interested in hospices’ provision of and billing for GIP. Whether hospice patients receive GIP levels of care in the hospice’s own facility or under arrangements with a local hospital or SNF, specific documentation is required to support the patients’ need for that level of care. The key to coverage of GIP is ensuring that the patient is eligible for this level of care and a better understanding of the appropriate circumstances to use GIP.
Documentation is the major factor in getting GIP covered for the hospice patient. Without accurate and detailed documentation, claims can be denied as not being medically necessary. Join this session with home care compliance expert Judy Adams, RN, BSN, who addresses the types of documentation that should and should not be used for GIP stays. Judy will discuss when GIP is appropriate and how documentation can make the difference between getting your claims covered or denied, as well as the importance of the collective documentation of all team members to support the appropriateness of GIP.
You will also explore lessons learned from OIG review and discuss why GIP will remain a focused area for review. You will be able to better understand the situations that meet the requirements for GIP, strategies to ensure your claims will be paid, the importance of discharge planning from GIP, and things you can do to avoid claim denials. The session will also incorporate information from the Medicare Hospice Benefit Manual and results from the OIG’s review of hospice claims for GIP over the last 5+ years.
Who Should Attend
Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.
- Michelle Crowell Coleman
Judy Adams, RN, BSN, HCS-D, HCS-O, has been involved in health care in numerous health care setting over the span of her career. She has been involved in nearly every aspect of home health care over the last three decades including direct clinical care, supervision, administration and quality improvement.