Qualifying for Hospice: It used to be so easy, Or, The death of General Debility and Adult Failure to Thrive

Qualifying for Hospice: It used to be so easy,

Or

The death of General Debility and Adult Failure to Thrive

Background

In 2002 General Debility accounted for 6% of all Hospice claims and Adult Failure to Thrive was 3%. In 2012 there were a lot more hospices and General Debility accounted for 12% of all claims and was the number 1 code used on all hospice claims and Adult Failure to Thrive accounted for 7%. Why were there a lot more hospices? The American public is becoming more sophisticated in its choices for health care. They turn to the internet and look up diseases and their prognosis. They want to have more control over the end of their life and the Baby Boomers are entering retirement and caring for their parents and themselves.

Center for Medicare and Medicaid (CMS) thoughts

General Debility and Adult Failure to Thrive are: “non-specific, ill-defined diagnosis”

Since 2008 hospice has been required to do a comprehensive, individualized assessment and plan of care and if a non-specific, ill-defined diagnosis is used as primary this cannot be done (according to CMS). CMS says “these diagnoses are incongruous to the comprehensive nature of the hospice assessment”. They can be used as secondary or related diagnoses but not as primary diagnosis.

What all this means at Front Range Hospice

The Administrator and the DON are rapidly educating themselves on Coding for Hospice. All patients that were coded with a primary diagnosis of general debility or adult failure to thrive we have done the research and changed the primary diagnosis. Underlying the General Debility or the Adult Failure to Thrive is a primary disease that is creating this condition. We have done the research, found this disease and with the assistance of our Medical Director, we have changed the primary diagnosis.

Going forward, we will do the research and find a primary diagnosis that is not General Debility or Adult Failure to Thrive. It is important to Front Range Hospice that patients receive the hospice care that they are entitled to. This means that we must request more records and do more digging some times before our Medical Director is comfortable certifying what the terminal illness is.