NotePush Blog

Hospice documentation, explained

LCD criteria, HOPE requirements, charting workflows, and audit defense — written for nurses, by people who've read the MACs.

CMS Compliance

HOPE replaced HIS on October 1, 2025. Here's what your agency needs to do.

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.

June 2026 · 6 min read

LCD / Eligibility

LCD L34538 in plain English: what every hospice nurse must know

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.

May 2026 · 8 min read

Recertification

Recertification documentation: what ADRs actually look for

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.

April 2026 · 5 min read

Clinical

Charting PPS correctly: the 10-point scale that can make or break your audit

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.

March 2026 · 4 min read

Audit Defense

When you get an ADR: a step-by-step response guide for hospice agencies

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.

February 2026 · 7 min read

Clinical / Dementia

FAST Scale for hospice eligibility: complete staging guide with documentation language

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.

June 2026 · 10 min read

LCD / Eligibility

LCD L34538 vs. L33393: which applies to your patient, and why it matters at audit

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.

June 2026 · 7 min read

Compliance

Face-to-face encounter documentation: the 30-day rule and what auditors look for

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.

June 2026 · 6 min read

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