Wash. HCA Hospice Services Billing Guide, What is the hospice certification process?

The hospice certification process is as follows:

When a client elects to receive hospice care, HCA requires a hospice agency to:

• Obtain a signed written certification of the client’s terminal illness.

-OR-

• Document in the client’s medical file that a verbal certification was obtained

and follow up with a documented verbal certification and a written

certification signed by:

o The medical director of the hospice agency or a physician staff member of

the interdisciplinary team.

o The client’s attending physician (if the client has one).

• Place the signed written certification of the client’s terminal illness into the

client’s medical file:

o Within 60 days following the day the hospice care begins.

o Before billing HCA for the hospice services.

Note: The hospice certification must specify that the client’s

prognosis is for a life expectancy of 6 months or less if the

terminal illness runs its normal course.

• For subsequent election periods, HCA requires the hospice agency to:

• Obtain a signed, written certification statement of the client’s terminal illness.

• Document in the client’s medical file that a verbal certification was obtained

and follow up with a documented verbal certification and written certification

signed by the medical director of the hospice agency or a physician member

of the hospice agency.

• Place the written certification of the client’s terminal illness in the client’s

medical file:

o Within two calendar days following the beginning of a subsequent election

period.

o Before billing HCA for the hospice services.

When a client’s hospice coverage ends within an election period (e.g., the client

revokes hospice care), the remainder of that election period is forfeited. The

client may reinstate the hospice benefit at any time by providing an election

statement and meeting the certification process requirements.

Note: The hospice agency must notify HCA Hospice program of

the start-of-care date within five business days of the first day of

hospice services for all clients for whom Medicaid payment will

be claimed. This includes clients with third-party or Medicare

coverage or both.