Medicare’s Keys to Documenting a Six-Month Prognosis: LCDs

1. What Is a Local Coverage Determination (LCD)?

In this chapter, we will discuss the three Medicare Administrative Contractors (MACs) that oversee hospice payment for Medicare providers and explain the history of the local coverage determinations (LCDs) developed by the MACs. We will learn how the MACs use the LCDs for audits of hospices across the country.

2. The Unipolicy of NGS and CGS

This chapter will identify the components of the CGS/NGS “Unipolicy” Hospice LCD, including the the LCD’s introduction, which discusses documentation, plateau, and overall intended use for the guidelines. We will investigate the “decline” policy, or “Part 1,” describing the patient’s decline as a predictor of six-month prognosis, and how these decline factors are listed, with most predictive at the top of the list and least predictive at the bottom.

3. Disease-Specific Guidelines (NGS/CGS)

This chapter will identify the specific indicators in the Unipolicy for cancer and noncancer diagnoses used as guidelines for a six-month prognosis. This includes disease processes like dementia, heart disease, and respiratory illnesses, for which it is more difficult to show a terminal prognosis.

4. Palmetto LCDs

This chapter identifies the specific Palmetto LCDs and how they differ from the Unipolicy of the other MACs. It is important to note that Palmetto also uses the International Classification of Functioning (ICF) model to show support for terminal decline in any illness. This chapter will introduce us to the ICF guidelines.

5. Using the LCD: From Admission to Discharge

This final chapter will utilize your knowledge of the LCDs and describe how they can be used throughout hospice operations to build a culture of compliance, from admission to recertification to discharge.