Ind. IHCP Hospice Services Provider Reference Module, Section 7, Other Hospice Review Criteria

The following criteria are used when a hospice review is conducted at the hospice agency and includes all

services billed to the IHCP by hospice and nonhospice providers for the specified review time period:

• The medical documentation of the hospice and nonhospice providers must support the services

billed to the IHCP.

• The services must be IHCP benefits.

• The services must be reasonable and medically necessary to treat the terminal condition and related

illnesses.

• The services must be billed in the quantities ordered and documented in the medical records as

provided.

• The services must be specifically identified on the provider’s itemized statements of the charge

receipt maintained by the facility.

• The services must be billed to the IHCP only after other medical insurance has been exhausted.

• The services must be billed in accordance with established IHCP policy.

• The physician must order the services in writing as indicated in the medical documentation.

The following documentation is not acceptable legally or from a patient care perspective under the IHCP

guidelines, and would subject the hospice and nonhospice providers to recoupment:

• Failure to document the IHCP member’s name on each page of the serv ice record is not acceptable.

A patient’s name is essential to ensure that the documentation is returned to the correct record, and

the record pertains to the member being reviewed.

• Scratch-outs, whiteouts, alterations, missing dates and missing signatures are not acceptable. All

documentation errors should be corrected using the following universally accepted medical records

method:

➢ Draw a line through the entry in ink and do not obliterate the word.

➢ Enter the correct information, initial and date the change.

• Failure to include signatures to authenticate all documentation of services rendered is not

acceptable. It is recommended that a full signature be used for each entry and each individual entry

must be signed, including at a minimum, the first initial and last name.

➢ If a first initial and last name is used, a master signature file must be maintained. The file should

contain a complete (first and last name) signature and the corresponding initial and last name to

be used for documentation purposes.

➢ If a service requires a certain licensure level, the individual should include their title or

credential in the signature.

Hospice providers are reminded prior authorization is not a guarantee of payment. Therefore, if the

hospice review team or Program Integrity team identifies an overpayment issue requiring recoupment, the

fact the provider has prior authorization does not keep the IHCP from initiating the recoupment process.