What Families Should Know About Hospice Transfers

Navigating Hospice Transitions

Hospice care is a compassionate approach to end-of-life care that focuses on the comfort and quality of life for the terminally ill. However, there may come a time when transferring hospice care is considered necessary. Understanding the rules, procedures, and implications of hospice transfers is crucial for families making these decisions. This article outlines what families should know about switching hospice providers, maintaining care continuity, and ensuring the patient's rights are respected throughout the process.

General Guidelines for Hospice Transfers

What are some general guidelines for hospice transfers?

When considering a change in hospice providers, patients need to be aware of several important guidelines. Firstly, patients may only change providers once per benefit period, which includes two 90-day periods followed by unlimited 60-day periods.

Documentation is essential during this process. Patients must file signed statements that detail the current and new hospice providers, including the effective transfer dates. This includes submitting a transfer agreement form to prevent any gaps in care. Additionally, both hospices need clear communication to ensure continuity and that assessments required by Medicare are completed.

Notifying the doctor about the transfer is also a critical step. The patient's physician must be kept informed to manage care effectively and coordinate any necessary medical interventions.

Continuity of care is vital during a hospice transfer. Patients should continue along the same benefit period timeline, and if an immediate transfer cannot occur, they may be discharged temporarily, causing a need for re-election of hospice services at the new provider. Such careful planning ensures that patients receive uninterrupted, high-quality care during this sensitive time.

Medicare Rules for Hospice Transfers

What are the rules governing hospice transfers according to CMS?

The Centers for Medicare & Medicaid Services (CMS) has established specific regulations for hospice transfers that ensure a seamless continuity of care for patients. Beneficiaries are allowed to transfer to a new hospice provider only once during each benefit period. This transfer must be documented with a signed statement that includes the names of both the current and new hospice, along with the effective date of the transfer.

To avoid any gaps in care, it is critical for patients to ensure that there is no break in services during the transfer process. If a lapse does occur, even for a short duration, it is deemed a discharge from hospice care. Patients would then need to re-elect hospice benefits with the new provider, resetting their eligibility periods.

How can care gaps during hospice transfer be avoided?

Maintaining continuous coverage during hospice transfer is essential. To prevent care gaps, the following steps are important:

• Initiate Transfer Early: Patients should start the transfer process as soon as they decide to switch hospices.
• Notify Both Hospices: It is important for the transferring hospice to inform the receiving hospice to begin coordination of care.
• Complete Documentation Timely: Securely handle transfer paperwork and keep both hospice teams informed.

When done correctly, these actions help ensure that patients receive uninterrupted care, thereby enhancing their overall quality of life during this sensitive time.

What billing and documentation practices are required during a hospice transfer?

Proper billing and documentation are crucial during hospice transfers. Both the transferring and the receiving hospices must:

• Document the Transfer: Maintain accurate records of the transfer process along with eligibility details.
• Coordinate with CMS: Make sure all documentation complies with CMS requirements to avoid claims rejections.
• Share Patient Information: Release necessary patient data to the new hospice provider to ensure continuity of care.

These practices help safeguard against billing issues while ensuring that patients continue to receive necessary services without interruption.

Consequences of a Hospice Transfer

How Does a Hospice Transfer Affect the Benefit Period?

One consequence of a hospice transfer is that it ends the patient’s current benefit period. This necessitates the re-election of hospice coverage at the new hospice, which begins a new benefit period. Under Medicare guidelines, a patient can transfer to a new hospice once during each benefit period, which includes two 90-day periods followed by unlimited 60-day periods. Therefore, while transferring, it is essential to keep track of the benefit period timelines.

The Importance of Avoiding Care Gaps

It is crucial to avoid any gaps in care during the transfer. Any period without coverage, even a single day, may lead to a discharge and re-admission situation, complicating billing and continuity of care under Medicare regulations. Timely communication between the current hospice provider and the new one can reduce the risk of service interruptions that could affect the patient's transition.

System Edits to Prevent Billing Issues During Transfers

Effective July 1, 2022, new system edits were implemented to prevent gaps in billing between hospice transfers, enhancing the management of claims. If a transfer does not occur immediately without a break, Medicare claims can be rejected, which leads to further complications in coverage for the patient. Maintaining continuous billing days and preventing any gaps is crucial for ensuring uninterrupted hospice care transitions, thus safeguarding the patient’s ongoing benefits.

Aspect	Details
Benefit Period Timeline	Two 90-day periods followed by unlimited 60-day periods.
Importance of Care Gaps	A gap, even for a day, results in discharge and re-admission.
System Edits Implementation	New edits help prevent billing issues during transfers since July 1, 2022.

In summary, understanding the implications of a hospice transfer on benefit periods, care gaps, and billing can greatly impact a patient’s hospice experience.

Dealing with Hospice Transfers

Managing the Transfer Process Effectively

Switching hospice companies can be a manageable process, but it requires careful planning and communication. Under Medicare regulations, patients can change hospice providers once during each benefit period. This period includes two 90-day cycles followed by an unlimited number of 60-day cycles, providing some flexibility in care choices.

To initiate a switch, contact your current hospice provider to request a transfer form. It is crucial to ensure that the handover occurs without unreasonable delay to maintain continuity in care. You will also need to document the transfer details, including both the current and new hospice names and the transfer date.

Communicating with the Current and New Hospices

Effective communication is vital in the transfer process. Notifying your doctor about the change in hospice care is essential for ongoing treatment management. This helps ensure that they are aware of your new care team, making it easier to coordinate medical care and support.

Both the current and new hospices should receive written documentation confirming the transfer to avoid any lapses in service. The new hospice will conduct required assessments to align your care plan with their standards.

Researching New Hospice Providers

Researching potential new hospice providers is another critical step for a successful transition. Look for hospices that align with your specific needs, such as the type of care they specialize in and their coverage options. Confirm insurance coverage to ensure that the new provider fits within your existing benefits and financial arrangements.

The Complexities of Hospice Paperwork

What should you know about hospice discharge and transfer paperwork?

Dealing with hospice discharge and transfer paperwork can be intricate and requires careful navigation. Patients are allowed to change their hospice providers once during their election period without jeopardizing their existing benefits. The key forms involved in this process include the Notice of Transfer and Type of Bill (TOB) 8XC. This form becomes necessary when a hospice receives a patient from another hospice within the same Medicare hospice benefit election period.

It’s crucial that this TOB 8XC is promptly submitted to Medicare after the transferring hospice has finalized its claim. Providers should keep an eye on the status of these submissions as Notices of Transfer can be rejected if they contain errors. If discrepancies are found, corrections can be made accordingly.

How paperwork impacts a transfer

The paperwork involved is not just about changing hospice providers; it also ensures continuity of care. A signed document must denote the current and new hospice providers, alongside the transfer date, facilitating a seamless transition. Patients must remain proactive in notifying their doctor of any changes to their hospice provider to ensure continuity in care management.

Differences between revocation and discharge

Understanding the nuances between revocation and discharge is essential. When a patient revokes their hospice care, they must submit a signed written document. This differs from a transfer, as revocation means the patient will lose Medicare hospice benefits. In contrast, a discharge, initiated by the hospice provider due to various reasons, can also terminate Medicare coverage, but it allows the patient to elect hospice care again should they meet eligibility requirements in the future. Therefore, both processes have distinct implications for a patient’s care and future options.

Understanding Hospice Discharge for Cause

What are the requirements for hospice discharge for cause?

Hospice discharge can occur for several reasons, particularly if there are specific disruptive behaviors exhibited by the patient. These behaviors can include abusive actions or an overall lack of cooperation, which can hinder the hospice team’s ability to provide effective care. For a discharge to be valid, the hospice must document all initiatives aimed at addressing these issues, maintaining detailed records in the patient's clinical file.

A written order from a physician is mandatory for any discharge not related to death, transfer, or voluntary revocation of services. Additionally, if a patient's health condition shows signs of improvement, discharge planning must commence. This process often includes family counseling and education on care needs following discharge.

Documentation and planning before discharge

The discharge process requires meticulous documentation and planning. All efforts to resolve any behavioral concerns should be logged, and consultative discussions with the family are crucial. This ensures that the family understands the reasons for discharge and is prepared for potential post-hospice care arrangements.

Compliance with Medicare regulations is also essential during discharge, as proper documentation helps facilitate a smoother transition and assures services aren't incorrectly terminated due to noncompliance issues.

Roles of family and hospice in discharge situations

Families play a vital role in the hospice care process, particularly during discharge situations. They must be engaged in all discussions regarding discharge, and they need education about what to expect following the patient's transition from hospice services. The hospice team works collaboratively with families, ensuring a comprehensive understanding of available options while also addressing emotional and logistical concerns associated with the care transition.

Patient Rights in Hospice Care

What rights do patients have in directing their hospice care?

Patients enjoy considerable rights regarding their hospice care, which prioritize their individual care goals and preferences. They possess the ability to refuse certain treatments and medications while working closely with their hospice care team to ensure that their personal wishes are honored. This support allows patients to focus on comfort and emotional well-being rather than aggressive curative treatments.

How are patient choices respected?

The hospice care model emphasizes patient autonomy, enabling them to consult with their primary care physician and withdraw from hospice if their condition improves. Each individual's preferences are acknowledged and integrated into their personalized Plan of Care.

What options exist for revoking or transferring hospice services?

Patients hold the right to revoke hospice services at any time, simply by submitting a written document. This revocation allows them to return to curative treatment options if desired. Moreover, they can transfer to a different hospice provider once during each election period, ensuring they receive the best possible care tailored to their needs.

Ensuring a Seamless Transition

Transferring hospice care can be an emotionally and logistically challenging process, but understanding the guidelines, maintaining proper documentation, and considering the needs and rights of the patient can lead to a successful transition. Families should communicate clearly with both current and prospective hospice providers, ensure all assessments and paperwork are in order, and prioritize the wishes and wellbeing of the patient. By following these steps, families can help ensure a smooth transfer that upholds the integrity and comfort central to hospice care.

References

• Discharges, Revocations & Transfers - NHPCO
• How Do Hospice Transfers Work?
• How to Change Hospice Care Providers - Compassus
• What Happens if I Get Better While in Hospice Care?
• Hospice - Center for Medicare Advocacy
• [PDF] Hospice Care - Medi-Cal
• 5 Things Every Family Should Know About Hospice Care
• Away From Home: How Hospice Works in a Hospital or Nursing Home