In the News: Change Requests and Conditions of Participation

Change Request 5971-Physician Signature Requirements

During the Centers for Medicare and Medicaid Services [CMS] May Open Door Forum, discussion focused on signature requirements for hospice physician orders, specifically for certification of election of hospice benefits. This information was released initially in Change Request [CR] 5971. This CR specified that a document must contain a legible identifier for service provided/ordered.  Handwritten or electronic signatures are acceptable forms of documentation, but a stamp signature was/is not acceptable. Documents covered by this Change Request included orders and medical review of medical record documentation. In addition, further clarification noted that facsimiles of signatures are permitted for certification of terminal illness forms. However the facsimile, hard copy signature or electronic signed form must be in each patient’s medical record in order that a valid certification of terminal illness for hospice to be in place.

CMS’s clarification also stated that the use of electronic systems adds an increase in the potential for misuse or abuse of alternate signature methods. When requested during a survey, medical review or upon CMS request, the hospice must be able to provide a hard copy of the physician's signature, i.e. either the original, a facsimile or an electronic signature that is legible and can be authenticated.

Change Request 5567- Hospice Visits and Charges Reporting

In July, CMS activates Change Request [CR] 5567 that requires each hospice to provide a weekly visit and charges report to CMS. This requirement has been met with opposition and has been refined from the initial CMS mandate. At this time the report is to include all nurses, social workers, home health aides and physicians and nurse practitioners [serving as a patient’s attending physician], but the inpatient setting reporting is limited to hospice employee visits. The directions indicate that only those visits deemed to be both reasonable and necessary are to be counted. The hospice must have its reporting process in place by July 1, 2008 in order to meet the new requirements and to continue to receive reimbursement for submitted claims.

There has been ongoing discussion relative to approaches to use in counting visits, how to determine what is a qualifying visit and the design and use of charge/visit templates.

Revised Hospice Conditions of Participation

The deadline for release of the Revised Hospice Conditions of Participation [CoPs] is the end of May 2008. It is expected that CMS will meet this deadline and that the revised CoPs will be released by this date. With this release date in mind, hospice providers will most likely be provided with a 60-day period to prepare to meet the revised CoPs. That means that an August 1 compliance date is expected. Providers are aware of the requirements contained within these CoPs, so preparation should already be underway. Summer vacation schedules should be maintained in alignment with staffing needs during the 60-day period from the release of the final CoPs to their implementation date. This will assist providers to be ready and in compliance by the implementation date established.

For more information on either of these Change Request initiatives or notification relative to the Release of the Final Hospice Conditions of Participation, access www.cms.hhs.gov. For detailed questions and answers relative to visit reporting, go to the questions and answers section of the website, i.e. https://questions.cms.hhs.gov.