Tackling the Challenge of Documentation to Support GIP Level of Care for Hospice Patients

Event Information
Product Format
Prerecorded Event
Presenter(s)
Judy Adams, RN, BSN, HCS-D, AHIMA approved ICD-10-CM Trainer
Conference Date
Wed, Nov 15, 2017
Length
90 minutes
Product Description

Learn How to Properly Document to Support General Inpatient Care (GIP) for Hospice Patients


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.

Session Highlights

  • Overview of the Medicare GIP hospice benefit
  • Summary of recent statistics about GIP level of care in hospice
  • Types of situations that are appropriate for GIP level of care
  • Summary of OIG studies of hospice GIP
  • Major reasons for denial of GIP claims
  • Recommendations from the OIG to CMS related to GIP
  • Basics of documentation needed to support the GIP level of care
  • Need for all members of the hospice team to document to support the appropriateness of GIP
  • Examples of documentation that does not support GIP
  • Examples of documentation that supports GIP

Session Agenda

  • Overview of Medicare hospice benefit
  • Levels of hospice care
  • General inpatient level of care (GIP)
    • When is GIP appropriate?
    • When is GIP inappropriate?
    • Why is GIP coming under scrutiny?
  • OIG studies on hospice GIP
    • March 2016 OIG report
    • Conclusions of 2012 hospice GIP study
    • Recent statistics on use of GIP
    • Major reasons for claim denials
    • Recommendations to CMS following GIP study
    • OIG follow-up study in September 2016
  • Why is documentation such a focus?
  • Admission and need for GIP
  • Development of the GIP plan of care
  • Use of quantifiable values/measures
  • Clinical documentation
    • Supporting documentation for skilled level
    • Acceptable documentation to support GIP
    • Actions to ensure your GIP claims are paid
    • Team involvement
    • Samples of documentation that supports GIP level of care
    • Samples of documentation that does not support GIP level of care

Who Should Attend

  • Hospice clinicians
  • Supervisors
  • Clinical directors
  • Hospice medical directors

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Judy Adams - Home Health Coding Expert

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.


In 2009, she opened her own education and consultation company with a primary focus on...   More Info
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