Tip of the Month
The Physician Narrative: More Than Just a Note!
T
he role of the hospice physician has expanded significantly in the last few years due to changes in the process for certification of a Medicare beneficiary’s terminal illness.
As Dr. Kevin Henning notes in this month’s cover story, beginning on October 1, 2009, CMS mandated that all certifications for hospice care (both initial certification and any recertification) include a physician-composed narrative statement explaining the rationale used by the physician to determine the Medicare beneficiary’s eligibility for hospice. The narrative statement can either make or break the outcome of a variety of audits that CMS and its contractors may conduct at any time. If hospice providers and their physicians view the narrative statement as a mere “checkmark on the initial or recertification process list,” then they have missed the rationale and benefit of imposing this requirement. The narrative statement should not only describe why a patient is eligible for hospice, but should also provide an all-important framework for interdisciplinary team documentation throughout the benefit period. The narrative should be concise, but also “paint the picture” of the patient’s eligibility. It is from this narrative statement that other members of the interdisciplinary team take their cue in all other notes thereafter concerning the patient’s eligibility. Making It Happen So, how can your organization ensure that its hospice physicians are composing adequate narratives? You may need to educate these physicians on how to compose meaningful narrative statements as well as educate other members of the interdisciplinary team on how the statements should be used as a “beacon” for their ongoing documentation. Finally, there should be an internal process in place to review your organization’s physician narrative statements on a periodic basis to proactively ensure they accomplish what they were intended to do. (Dr. Henning shares the process his organization followed to both audit and improve its physician narrative statements. Click the purple button on page 6 to save a print-friendly copy of the article to share with others.)
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NewsLine
Table of Contents for the Digital Edition of NewsLine - July 2012