NotePush Blog
LCD criteria, HOPE requirements, charting workflows, and audit defense. Written for nurses, by people who’ve read the MACs.
CMS Compliance
The Hospice Outcomes and Patient Evaluation tool is now the CMS standard. Miss 90% submission and you lose 4 APU points. Roughly $80–200K per year depending on census. The penalty is quiet, compounding, and avoidable.
LCD / Eligibility
Nobody handed you a copy of LCD L34538 when you started in hospice. Most nurses have absorbed fragments of it from ADRs and colleagues. But the gaps are expensive. Here's the whole thing, translated.
Recertification
The physician signed the cert. The IDG agrees the patient qualifies. But if the chart shows PPS 60 every visit for four months and the narrative is nearly identical to the last one, that's the chart that gets denied.
Clinical
Auditors have seen enough hospice records to know that most agencies cluster their PPS scores in a band around 40–50 for almost every patient. Real patients don't work that way. Charts that don't reflect actual variation get flagged.
Audit Defense
The envelope arrives on a Tuesday. Inside: seven patient record numbers and a 45-day clock. An ADR is not a denial. But how you respond determines whether it becomes one.
Clinical / Dementia
You already know what FAST 7A looks like. The patient who only says 'mama' now. What you may not know is that 'FAST 7' without the substage is one of the most common reasons a claim gets denied. Here's the complete guide.
LCD / Eligibility
Nobody tells you there are two hospice eligibility LCDs. You learn L34538 because it's in the training materials. L33393 comes up later, usually when a patient doesn't fit cleanly into any category. Here's how to choose, and document to, the right one.
Compliance
You scheduled the face-to-face for day 157. Benefit period 3 starts day 181. That's 24 days. Well within the 30-day window. Or so it seemed. Here's how the window actually works, and the documentation failures that make valid encounters invalid.
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