After selecting a hospice, patients can choose their regular doctor, nurse practitioner (NP) or physician’s assistant (PA) as their attending physician, provided the individual is not associated with the selected hospice.

If a patient chooses an attending physician, that physician will have the most significant role in determining the type of medical care the patient receives as well as ensuring the patient is satisfied with the quality of care they receive. Keep reading for the responsibilities of the hospice attending physician and how to make these the most efficient in order to deliver high-quality hospice care.

Attending physician documentation

When a patient chooses an attending physician, the clinician must record the attending physician’s identifying information on the election statement, providing enough information to clarify which physician, NP or PA will serve as attending physician. The attending physician information should at least include the following: full name, office address or National Provider Identifier (NPI) number. In addition, an acknowledgement of the patient’s/patient’s representative choice for attending physician, as well as the signature of the patient/patient representative, must be included.

All blanks on the election of benefits must be completed. If there is a checkmark for yes or regarding election of chosen physician, one or the other must be checked. If no external attending physician is selected, either enter the hospice physician’s full name or write “no attending elected.” The clinician must not leave any blanks unresolved on the election form.

Written certification requirements

For the first 90-day period of hospice coverage, the attending physician must give oral or written certification of terminal illness. This certification must occur 15 days prior to the hospice election date or two days after. If a PA or NP is serving as the attending physician, only the hospice physician certification is necessary. The clinician must document evidence of the oral certification in the eligibility assessment, as well as in the medical record. If an oral certification was obtained, the hospice must get a written certification of terminal illness from the attending physician before submission of a claim, which must be included in the patient’s medical record.

  • A complete written certification must include:
  • The “patient’s medical prognosis is that their life expectancy is six months or less if the terminal illness runs its normal course.”
  • “Specific clinical findings and other documentation supporting a life expectancy of six months or less.”
  • The certification must include physician’s signature, date signed and the benefit periods that the certification covers. The signature must be handwritten or electronic. Stamped signatures are not acceptable. If the physician used a scribe, the scribe does not have to sign/date the certification; the attending physician’s signature indicates the physician confirms the scribe correctly documented the certification. If the attending physician forgets to date the certification, the hospice can obtain a notarized statement verifying when the certification was given.

Physician narrative requirements
Usually, the hospice physician composes the physician narrative. The narrative must indicate the patient’s individual clinical facts. “The narrative cannot contain check boxes or standard language for all patients.” The physician must create the “brief clinical justification narrative” from the patient’s comprehensive medical record or physical exam. The physician narrative can be part of the certification form, or it may be an addendum. The narrative must be located immediately above the physician’s signature, if the narrative is part of the form. If the narrative is an addendum to the form, the physician’s signature must be on the certification form, as well as immediately following the narrative in the addendum. The narrative must also include a statement directly above the physician signature attesting that, by signing, the physician confirms that they created the narrative based on their review of the patient’s medical record, or their examination of the patient. The narrative can be dictated.

The attending physician chooses how involved they want to be in the patient’s care, selecting to be notified for orders for management of patient pain and symptom, or passing the responsibility to the hospice physician. If a patient selects an attending physician, that physician can continue to bill office visits for the hospice diagnosis. If the attending physician chooses not to sign the certification of terminal illness or be the patient’s attending physician, the elected hospice must document every attempt to reach the selected physician, every conversation with the selected physician or their staff and reach out to the patient or representative and have a change of attending physician form completed. The patient may choose a different community physician, NP, or PA, or they may choose the hospice physician to be their attending physician.

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