Admission Eligibility Protocol and Eligibility Team Description

Admission Eligibility addresses reducing implicit bias in admission decision making. Implementing this protocol requires moderate team effort and results can be immediate.

• Digital download
• Admission Eligibility Protocol PDF file

Many hospices have single points of failure in their admission process. Whether it is within your intake department, your admission nurse, or your hospice physician, they all bring prior experiences and other elements that can bias your admission process, potentially denying admission to eligible patients. Our protocol sets up an eligibility team to review patients who have been initially denied, along with a referral and admission template to assist with the patient's presentation. To be clear, per CMS regulations, it is the hospice physician and referring or attending physician’s decision to admit or not . However, setting a process that brings all factors to light av oids single point s of failure.

Benefits:

• To ensure that patient eligibility is evaluated consistently and objectively so that no eligible patient is denied their hospice benefit and that no ineligible patients are admitted.
• Creates a learning environmen t for all involved in hospice eligibility.
• It can be a learning opportunity for referral sources to why the patient is or is not hospice eligible . It also can reassure referral sources that you did everything in evaluating the patient for hospice .
• This a lso allows you to challenge more aggressive providers in your marketplace , as your hospice h as an in - depth process and rationale to determine eligibility when the referring physician says, “I’ll send this patient to another hospice .”

Index:

• 9 Step Protocol
• Eligibility Description
• Referral Form
• Admission Template