Election-Statement-Form

Update your Hospice Election Statement

Hospice providers should be aware of a recent Medlearn Matters article that includes instruction for Hospices to update their Election Statement form to include specific details on the attending physician.  This information was previously noted in the 2015 final payment rule, however some of the elements such as the Attending NPI were listed as something that could be used, not that it would now be required to be included.

Please update your forms and processes to start gathering the necessary information. The effective date of the transmittal is May 4, 2015. Updated election statements must include the patient’s choice of attending physician. The information identifying the attending physician should be in enough detail so that it is clear which physician or NP was designated as the attending physician. This must include, but is not limited to, the attending physician’s name and National Provider Identifier (NPI). CMS stated that Hospices do have the flexibility to include this in a format that works best for them as long as the requirement is met. The language on the election form should include an acknowledgement by the patient (or representative) that the designated attending physician was the patient’s (or representative’s) choice.

In the past, some of the Medicare Administrative Contractors (MACs) such as CGS have created and published sample Hospice Election Statements. Here is an example of the current CGS sample which has not yet been updated to include the new required data elements: http://www.cgsmedicare.com/hhh/education/materials/pdf/sample_hospice_election_form_h-045-01_09-2011.pdf. HEALTHCAREfirst will continue to monitor this topic and will publish links to any new samples as they are made available by the MACs along with any additional clarifications.

For further details, the Medlearn Matters article can be located here.

The Change Request/Transmittal can be located here.

April 13, 2015
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