Wash. HCA Hospice Services Billing Guide, What are the notification requirements for hospice agencies?

To ensure a hospice client receives quality of care, and to ensure HCA determines

accurate coverage and reimbursement for services that are related to the client’s

terminal illness or related conditions, a hospice agency must meet certain

notification requirements.

To be reimbursed for providing hospice services, the hospice agency must

complete HCA/Medicaid Hospice Notification form, HCA 13-746, and forward the

form to HCA's hospice program within five business days from when an HCA

client begins the first day of hospice care or has a change in hospice status. Case

managers must determine if clients will need Medicaid eligibility when electing

hospice. If a person electing hospice applies for Medicaid, the HCA/Medicaid

Hospice Notification form, HCA 13-746 must be submitted to determine the

correct program.

The hospice agency must notify HCA’s hospice program of all of the following:

• The name and address of the hospice agency

• The date of a client’s first day of hospice care

• A change in a client’s primary physician

• A client’s revocation of the hospice benefit (home or institutional)

• The date a client leaves hospice without notice

• A client’s discharge from hospice care

• A client’s admittance to a nursing facility. (This does not apply to a client

admitted for inpatient respite care or general inpatient care.)

• A client’s admittance to or discharge from a nursing facility/hospice care

center, except for General Inpatient (GIP) hospice care or respite

• A client who is eligible for or becomes eligible for Medicare or third-party

liability insurance

• A client who dies

Note: When a hospice agency does not notify HCA within five

business days of the date of the client’s first day of hospice care,

HCA authorizes the hospice daily rate or nursing facility room

and board reimbursement effective the fifth business day prior to

the date of notification.