Wash. HCA Hospice Services Billing Guide, When are face-to-face encounters required?

The referring provider must have a face-to-face encounter with every hospice

client:

• Within 30 days of the 180th day recertification.

• Before each subsequent recertification to determine if the client continues to

meet eligibility for hospice care. (In other words, a physician or ARNP certifies

that the client’s life expectancy is six months or less, that the client’s condition

continues to decline, and that the client continues to meet criteria for hospice

level of care.)

Note: HCA does not pay for face-to-face encounters to recertify

a hospice client.

The referring provider must attest that the face-to-face encounter took place.

The hospice agency must:

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

• Follow-up a documented verbal certification with a written certification signed

by the medical director of the hospice agency, or physician staff member of

the hospice agency.

• Place a 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.

Hospice agencies must submit a written certification to HCA with the hospice

claim related to the recertification. The written notification can be added to the

claim after the claim has been received by HCA.

For instructions on how to add attachments to claims, see the ProviderOne

Billing and Resource Guide.