How to Win a Hospice Eligibility Case: What Arguments Are You Leaving on the Table?

Friday, May 1, 2015: 2:15 PM-3:15 PM
National Harbor 2 (Gaylord National Resort and Convention Center) - 3rd Level
Primary Presenter:
Meg S.L. Pekarske, JD , Reinhart Boerner Van Deuren S.C., Madison, WI
Bryan K. Nowicki, JD , Reinhart Boerner Van Deuren S.C., Madison, WI
In this session, faculty will share strategies they use in a variety of appeals to support and defend hospice eligibility decisions. Participants will learn different ways to challenge eligibility decisions, from affirmatively demonstrating terminal prognosis by telling the patient's story to dissecting clinical decisions to prove how and why the reviewer is wrong.  Faculty will also help hospices understand how to think beyond the clinical arguments and bolster their appeals with established legal support that most hospices are unfamiliar with, such as the treating physician rule and waiver of liability under the Social Security Act.  Additionally, they will discuss how these appeal strategies should inform how hospices document terminal prognosis to avoid future denials.

Learning Objectives:
1. Discuss realities and other considerations that define your hospice's approach to appeals
2. Identify elements of effective hospice appeals and appeal strategy
3. Identify issues related to Administrative Law Judge (ALJ) hearings

CE/CME: Nurse, Physician and Social Worker
See more of: 60-minute session