Announcements
HOPE will be available for testing in your environment July 2025
Stay Tuned for More HOPE Updates Soon!
Basic Workflows in Knowledge Base
FAQ
iQIES Service Center(opens in a new tab) Assists with questions related to the HIS and HOPE data submission or other technical assistance information including error messages or record rejections.
- Phone Number: 1-800-339-9313
- Monday-Friday 8:00 a.m. - 8:00 p.m. ET
IQIES Training:
https://qtso.cms.gov/training-materials/iqies-training-videos
CMS Resources:
CMS HOPE Frequently Asked Questions
CHAP Resources:
CHAP HOPE Assessment Tool: Administration & Preferences
CHAP: HOPE- Managing Special Circumstances
CHAP CMS Hospice-Stay Compliance Quality Quick Guide
Hospice Tools Help Guide:
Hope Workflow Documentation and Dashboard
Hospice Tools Checklist:
Hospice Tools HOPE Training:
The Instructions provided below are from CMS directly. For more information contact the QIES Helpdesk directly at 800-339-9313 or E-mail: help@qtso.com
CMS Help Guides:
Getting Started with the Hospice Quality Reporting Program
CMSNET Remote Access Request Portal Instructions
Timeliness Compliance Threshold for HIS Submissions: Fact Sheet
A Facility ID (FAC_ID) is the CMS assigned a unique facility identifier that must be entered into your EMR for HIS record submissions assigned to the provider for submission processing. This ID is used to identify submissions from your provider. You will receive this ID when you obtain your QIES user ID. If you did not receive a facility ID contact CMS directly. QIES Helpdesk: 800-339-9313 or E-mail: help@qtso.com
Help Guide:
Company & Office Management- Facility ID
Hospice Item Set (HIS) is a patient level data collection tool developed by CMS. Hospices are required to submit a HIS Admission record and a HIS-Discharge record for each patient for ALL payer sources. Completing and submitting HIS forms in a timely fashion is a regularly issue that can impact payments to your hospice Agency.
Resources:
Timeliness Compliance Threshold for HIS Submissions: Fact Sheet
Hospice Tools Help Guides:
How-To Video:
Help Guide:
Associated FAQ:
Step 1: From edocs, click into the document, and request a Document Deletion Request This will remove the document from the chart, once the deletion has been approved by the DON or Administrator
Step 2: From timekeeper proceed to rerun Compliance Validation
This will un-verify the entries allowing the admin to remove them
*If you have closed the pay period, submit a support ticket to support@hospicetools.com and they will unwind the closed pay period
Although a supplement is not considered a medication, using the medication forms in Hospice Tools ensures that the supplement filters to the dashboard for transparency purposes.
Using the medications forms also guarantees that the supplement request filters to the MD's dashboard for signature.
We recommend utilizing the Drug Formulary in the software to add the most commonly used supplements so they are easily searchable when completing the medication forms. Saving the supplement to the formulary, will save time when completing the medications forms in Hospice Tools.
Help Guide:
RXNT- e-Prescribing - If interested in RXNT ask your Client Success Representative to connect you with our assigned RXNT representative for Pricing, Onboarding and Training. Once you have completed the initial RXNT training and security processes you'll want to schedule a training to review the workflow in Hospice Tools.
If using RXNT, the Medication forms in Hospice Tools should NOT BE USED, this will cause duplicates in the software. All medications should be filled directly in RXNT and sync back into Hospice Tools.
- Once fully onboarded with RXNT, contact your Client Success Representative to initiate a support ticket to enable your RXNT integration in Hospice Tools
- Once the integration is enabled, Click into External Credentials section, enter your username and password: RXNT Credentials Help Guide
- From the Medications chart section, Click the Open Patient in RXNT , and proceed to fill the applicable medication orders, or send them to pending for your Medical Director to sign
- From Hospice Tools, via the Medication tab, Select Sync Medication from RXNT to pull the medications back into the Medication Dashboard in Hospice Tools
* Please Note: If using RXNT, you'll want to also use a preferred PBM, and/or private pharmacy. RXNT does not dispense the medication 8358 files for billing purposes.
Help Guide:
PBM-Ask your Client Representative for a list of applicable PBM vendors & Contact Information
- If working with one of the applicable vendors, the PBM will automatically dispense the medication files on an automatic basis, normally this occurs monthly, however the provider can request that the vendor transmit the files on a more frequent basis.
- From edocs , the medication forms (comfort kit, single medication, or multiple medication form) should be used to identify the medications , where they are electronically signed by the appliable Medical Director and/or NP. Once the medications forms have been signed in edocs, the Patient details, and medication(s) identified will filter on the backend of the system to the provider's PBM dashboard.
**Providers cannot access the PBM portal through the Hospice Tools dashboard, a separate browser tab should be opened to access the patient details to proceed with filling the medication orders.
Private Pharmacy-Hospice Tools does not directly integrate with private pharmacies, a aggregate 8358 file template can be sent to the pharmacy ,and then needs to be sent directly to the provider ,and manually uploaded into the ebilling module.
Billing & Claims:
- The 8358 aggregate file should be sent directly from the pharmacy to the provider monthly, or established frequency as directed by you ( weekly, biweekly).
- Once the file has been received from the pharmacy, proceed to upload the aggregate 8358 file under the Prescriptions tab, located in the billing module: Prescription File Upload Help Guide
- Ensure if there are any errors with patient names that these are corrected prior to transmitting your claims to Medicare
eDocs and Medication Forms
- From edocs , the medication forms (comfort kit, single med, multi medication), located within the Medication Tab of the patients chart should be used to indicate which medications need to be ordered for the patient. The order will filter to the MD/and or NP's task box to sign
- Follow your private pharmacies process for filling the patient's medication (The process of filling these orders depends on the pharmacy you use. ( Calling the orders in, writing a prescription, faxing or emailing to the pharmacy to fill the order).
In order for your medications to be billed appropriately ,one of the important tasks that will need to be taken care of before you begin generating claims is to ensure your medication files are loaded from your pharmacy and/or PBM into ebilling.
If you do not have a dedicated pharmacy, this may be difficult , however is necessary for Medicare compliance & ordering of patient's medications.
Options:
Private Pharmacy-Billing & Ordering Processes
PBM- Billing & Ordering Processes
To edit a document in Hospice Tools, click into the original document and select the amend/correct button in the upper right hand corner of the document. Proceed to select the edit button in the area that needs to be corrected.
Help guide:
How-to-Video:
External Recourses:
CHAP Medication Reconciliation
Help Guide:
You will need HR manager permissions within User Management, located under System Access.
Help Guide:
To assign specific compensation to work types and employee type, you will need eDocs User Management permission.
Help Guide:
Help Guide:
To add employees into the Hospice Tools EMR you will need: Edocs user manager. This is located within the SYSTEM ACCESS field in User Management.
Hospice Tools is not responsible for managing provider's employees user permissions ,system access, or job titles. If you are the owner of the agency please contact your client success rep directly for further assistance.
Help Guides:
User Management- Employee Setup
Job Title & System Access Permissions
How To Video:
Help Guide:
Mileage should be logged using the TimeKeeper module. Timekeeper can be accessed via the mobile apps or via the desktop version, by selecting TimeKeeper.
Help Guide:
The Master Payroll report is to show all accumulated hours and mileage for the selected pay period.
Help Guide:
The Timekeeper Daily Activities with Gaps Report shows time duration between activities for all employees.
Help Guide:
The Admin Override Report is used to identify time entries that were overridden by the administrator within and outside the pay periods.
Help Guide:
TimeKeeper Admin Override Report
Employee's can request PTO through the TimeKeeper portal. Adjustments can also be made by an administrator through user management within the Employee tab and TimeKeeper with TimeKeeper administrator permission.
Help Guides:
User Management PTO Adjustment
Admin PTO Adjustment via TimeKeeper
To indicate PTO is being used, the employee will go through the TimeKeeper module.
Step 1: Within the edocs in the upper right hand corner, click on your name and select TimeKeeper
Step 2: The EMR will open up TimeKeeper in a second tab within your browser
Step 3: Proceed to select Time Entry at the top of the screen within the toolbar, or Click the Today button to bring you to the current time sheet. Proceed to select the date from the calendar displayed to the left of the screen to select an upcoming date
Step 4: Click the +Add button and proceed to enter a start and end time.
Step 5: Within the Activity Type drop down menu select PTO
Step 6: Click Save & Verfiy
Help guide:
412.22 Certification of terminal illness: As of January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient whose total stay across all hospices is anticipated to reach the 3rd benefit period. The face-to-face encounter must occur prior to, but no more than 30 calendar days prior to, the 3rd benefit period recertification, and every benefit period recertification thereafter, to gather clinical findings to determine continued eligibility for hospice care. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.22
Hospice Tools Help Guides:
Face to Face Encounter from the Patient's Chart
Recertification/Face to Face Report
External Resources:
CMS Hospice Face to Face Fact Sheet
Code of Federal Regulations-Certification of Terminal Illness
For the initial 90-day period, the hospice must obtain written certification statements and oral certification statements from the medical director of the hospice or the physician member of the hospice interdisciplinary group, and the individual's attending physician, if the individual has an attending physician.
For subsequent periods, the only requirement is certification by the medical director of the hospice.
Resources:
Initial Certifications & recertification of terminal illness should be performed by the medical director of the hospice or the physician member of the hospice’s IDG.
Recertification may be completed no more than 15 calendar days prior to the start of the subsequent benefit period.
The RN case manager directly involved in the patient's care can perform a nurse recertification as an "administrative component" in order to assist the Medical Director in making the final determination of a life expectancy of 6 months of less. It is recommended that they complete the nurse recertification within the specific time frame in order to have enough time to gather enough information so that the medical director can make the final determination of a life expectancy of 6 months of less.
*The nurse recertification documentation included within the Hospice Tools EMR is not a requirement per Medicare Benefit Policy.
A complete written certification/recertification must include:
1. The statement that the individual’s medical prognosis is that their life expectancy is 6 months or less if the terminal illness runs its normal course
2. Specific clinical findings and other documentation supporting a life expectancy of 6 months or less
3. The signature(s) of the physician(s), the date signed, and the benefit period dates that the certification or recertification covers (for more on signature requirements, see Pub. 100-08, Medicare Program Integrity Manual, chapter 3, section 3.3.2.4)
4. As of October 1, 2009, the physician’s brief narrative explanation of the clinical
findings that supports a life expectancy of 6 months or less as part of the certification and recertification forms, or as an addendum to the certification and recertification forms
Resources:
eCFR :: 42 CFR Part 418 -- Hospice Care
The intial, recertification, and Face to Face encounter documents automatically filter to the MD's task box on the main home screen of the Hospice Tools dashboard.
Each task has the name of the patient, identified assigned and due date. The dashboards located in 360 automatically create the document and filter it to the applicable employee to complete the task within the required timeframe.
All documents can be also be directly accessed through the Patient's chart under the Certification's tab.
Help Guides:
Medical Director CTI- From Patient's Chart
Initial Certification Dashboard
The Active Care Plan report allows you to see all active care plans for each patient which includes severity score and last update.
Help Guide:
The bereavement caregiver report should be run on a monthly basis to view all caregiver contact information for every expired patient.
Help Guide:
The Bereavement CQI report is used to view which bereavement documentation has been completed for each patient
Help Guide:
The unfinished forms report will show all documentation that has been created by a staff member, for each patient, and the date and time it was created. The report also identifies all documentation that is currently awaiting a signature from one or more associated team members.
Help Guide:
The DNR report can identify which patients have a DNR designation in the intake screen and which of those patients have an official document in their chart.
Help Guide:
Action items are connected to a required documentation that is missing or a patient intake information that needs to be updated.
Help Guide:
The IDG Dashboard is located in 360 tab. The IDG dashboard should be utilized every 15 days min. or weekly rolling if you have multiple IDG teams or IDG meeting every week:
- Full agenda sheet of patients with critical patient information
- Easy chart access
- Start new IDG update & review previous right from the dashboard
-
Patient's sorted by status and case manager for streamlined meetings
Help Guides:
Checklist:
How -To-Videos:
Hospice Tools Suggested Workflow:
- Complete the Psychosocial Assessment: The assessment should be completed within 5 calendar days of admission. The psychosocial assessment is located in the Assessments chart section
- Veteran History Checklist: If a patient is a veteran, complete within 5 days of start of care
- Complete the Psychosocial Visit Note : The visit note can be used to document scheduled visits or PRN visits. Document a patient and family's mental, emotional, and behavioral status in addition to needs for spiritual support. The last page of the visit note contains the symptom based care plan dashboard prompting social worker to identify any new or update on existing problems
- Social Worker Progress Note: The Social Worker Progress Note can be used for a variety of situations including PRN visits, missed visits, phone calls, care plan meetings, care coordination, etc. One of it's primary uses is for providing an IDG update. See help guide: https://www.hospicetools.com/wp-content/uploads/2024/02/IDG-Narrative-Progress-Note.pdf
- Care Plan & Update: The symptom based care plan dashboard: https://www.hospicetools.com/wp-content/uploads/2024/01/How-to-CreateUpdate-Discontinue-Care-Plans.pdf is located within Plan of Care chart section as well as the last page of the Psychosocial visit note. The overall plan of care needs to be updated with any changes in problems, goals, & interventions every 15 days min.
- Patient Incident Report: To be completed as needed to document incidents that occur such as falls, suspected abuse/neglect etc. The patient incident report is located in the Miscellaneous chart section
- Volunteer Request Form: To be completed as needed when patient/caregiver requests a volunteer (if request is made of spiritual counselor). The request form is sent to volunteer coordinator for review and volunteer assignment
Hospice Tools Suggested Workflow:
- Complete the Spiritual Assessment: The assessment should be completed within 5 calendar days of admission. The spiritual assessment is located in the Assessments chart section.
- Complete the Spiritual Visit Note : The visit note can be used to document scheduled visits or PRN visits. Document a patient and family's mental, emotional, and behavioral status in addition to needs for spiritual support. The last page of the visit note contains the symptom based care plan dashboard prompting spiritual counselor to identify any new or update on existing problems.
- Spiritual Progress Note: The Spiritual Counselor Progress Note can be used for a variety of situations including PRN visits, missed visits, phone calls, care plan meetings, care coordination, etc. One of it's primary uses is for providing an IDG update. See help guide: https://www.hospicetools.com/wp-content/uploads/2024/02/IDG-Narrative-Progress-Note.pdf on using the Progress Note for IDG updates
- Care Plan & Update: The symptom based care plan dashboard: https://www.hospicetools.com/wp-content/uploads/2024/01/How-to-CreateUpdate-Discontinue-Care-Plans.pdf is located within Plan of Care chart section as well as the last page of the spiritual visit note. The overall plan of care needs to be updated with any changes in problems, goals, & interventions every 15 days min.
- Patient Incident Report: To be completed as needed to document incidents that occur such as falls, suspected abuse/neglect etc. The patient incident report is located in the Miscellaneous chart section
- Volunteer Request Form: To be completed as needed when patient/caregiver requests a volunteer (if request is made of spiritual counselor). The request form is sent to volunteer coordinator for review and volunteer assignment
Resources:
Hospice Tools Spiritual Counselor Checklist
NHPCO Medicare COP Spiritual Caregiver
Within the Timekeeper module, indicate the start and end time, select Office/Administrative, and proceed to click Save & Verify.
Hospice Tools Help Guide:
Volunteer Administrative Hours
Additional Resources:
Medicare Hospice Conditions of Participation Volunteers and Volunteer Managers
https://allianceforcareathome.org/wp-content/uploads/418.78.pdf
The SFP is a program conducted by the Centers for Medicare and Medicaid Services (CMS) to identify hospices as poor performers, based on defined quality indicators, in which CMS selects hospices for increased oversight to ensure that they meet Medicare requirements.
The SFP implementation is on January 1, 2024. However, on the CMS Hospice Forum Call on November 14, 2023, they indicated that while the effective date of the SFP is January 1, 2024, the selection of hospices for the SFP is not expected to begin until late 2024.
For more information: CMS Hospice Special Focus Program
Consumer Assessment of Healthcare Providers and System (CAHPS) is a national survey of family members or friends who cared for a patient who died while under hospice care. The survey is conducted monthly ,and contains 47 questions covering topics of interest to family caregivers and hospice patients. Survey results are published as part of Care Compare on the www.Medicare.gov website.
For more information: https://www.cms.gov/medicare/quality/hospice/cahpsr-hospice-survey
HVLDL measure indicates the hospice provider’s proportion of patients who have received visits from a registered nurse or medical social worker (non-telephonically) on at least two out of the final three days of the patient’s life.
External Resources:
CMS Medicare Fact Sheet- Hospice Visits when death is imminent
Hospice Tools Help Guide:
End of Life Visit Count Report
412.22 Certification of terminal illness: As of January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient whose total stay across all hospices is anticipated to reach the 3rd benefit period. The face-to-face encounter must occur prior to, but no more than 30 calendar days prior to, the 3rd benefit period recertification, and every benefit period recertification thereafter, to gather clinical findings to determine continued eligibility for hospice care. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.22
Hospice Tools Help Guides:
Face to Face Encounter from the Patient's Chart
Recertification/Face to Face Report
External Resources:
CMS Hospice Face to Face Fact Sheet
Smart care plans allow you to develop individualized symptom based care plans to address specific problem(s), in order to establish measurable goals, interventions and outcomes to ensure your patients are receiving the best quality care.
How-to-video: Smart Care Plans dashboard
Help Guide: Symptom Based Care Plan Dashboard
*Please note the individualized care plans should be updated at a minimum of every 15 days if not more often as the patient's condition requires as they encompass the patient's overall plan of care.
Care plan problems, goals, and interventions can be modified at any time to fit your agency's needs. To submit a request send a support ticket to support@hospicetools.com and include any additional problems you would like added along with accompanying suggested goals, interventions, and outcomes.
Interdisciplinary Group, Care Planning, and Coordination of Service
418.569(d) Standard: Review of the Plan of Care eCFR :: 42 CFR 418.56 -- Condition of participation: Interdisciplinary group, care planning, and coordination of services
Specific (Simple, Sensible, Significant)
Measurable (meaningful, motivating)
Achievable (agreed, attainable)
Relevant (reasonable, realistic, resourced results-based)
Time Bound ( time-based, time limited, time/cost limited, timely, time-sensitive)
§418.56(b) Standard Plan of Care: All hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire. The plan of care must review, revise, and document the individualized plan as frequently as the patient's condition requires, but no less frequently than every 15 calendar days. This includes any of the SMART care plan problems being addressed. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/section-418.56
Standard: Content of the plan of care: The hospice must develop an individualized written plan of care for each patient. The plan of care must reflect patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including the following:
-
- Interventions to manage pain and symptoms.
- A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs.
- Measurable outcomes anticipated from implementing and coordinating the plan of care.
- Drugs and treatment necessary to meet the needs of the patient
- Medical Supplies an appliances necessary to meet the needs of the patient.
- The interdisciplinary group's documentation of the patient's or representative's level of understanding, involvement, and agreement with the plan of care, in accordance with the hospice's own policies ,in the clinical record
Plan of Care Resources:
SOM-Appendix M-Guidance to Surveyors
CHAP Hospice Standards of Excellence
https://www.hospicetools.com/wp-content/uploads/2024/01/Hospice_Plan_of_Care_05_2023_Final-1.pdf
https://qsep.cms.gov/pubs/ClassInformation.aspx?cid=0CMS_HSP_QIF_1
418.76 Condition of participation: Hospice aide and homemaker services
All hospice aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section. Homemaker services must be provided by individuals who meet the personnel requirements specified in paragraph (j) of this section. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/subject-group-ECFR74797288a614803/section-418.76
(g)Standard: Hospice aide assignment and duties
Hospice aides are assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group. Written patient care instructions for a hospice aide must be prepared by a registered nurse who is responsible for the supervision of a hospice aide
Help Guide:
Additional Resources:
https://www.cms.gov/files/document/mln7840862-enhancing-rn-supervision-hospice-aide-services.pdf
Congratulations on passing your survey!
For all patients that were on care prior to your certification date you'll want to immediately proceed to discharge and then readmit your patients as if they were never on your care, indicating the new admission date as the official date of certification. (This does not include expired patients)
All patients prior to your agency becoming certified were on care "pro-bono". In order to successfully bill Medicare & any other insurances for hospice All new admission paperwork needs to be completed to reflect this new date of certification. This includes all initial assessments, CTIs, Informed Consent, Benefit Election to reflect the new date of certification. DO NOT wait until Medicare enrollments are processed to do this.
The Cert period information on the patient's intake screen should be left BLANK, until you are connected to billing and have the ability to run the patient's eligibility in the system in order to accurately reflect the appropriate date to be entered into the Cert Begin field. This will allow you to identify which benefit period the patient is currently in.
If you're not able to add payor sources you'll need to complete the ebilling set up form to have Medicare added, and the Payer Request form to add other insurances.
Help Guide:
How-to Video:
Additional Resources:
Billing Forms:
Medicare surveys for compliance with the CoPs ( Conditions of Participation) are completed by state agencies or deemed status accrediting bodies no less frequently than once every three years to review the hospices compliance with the CoPs (Subpart C and D of the Medicare hospice regulations). However, surveys may occur at any time as a result of a complaint. A state may also do separate state licensure surveys. When deficiencies are cited (standard or condition level), a plan of correction is required, and a follow up survey may occur.
Resources:
SOM Appendix M Guide to Surveyors
NHPCO Hospice Survey Readiness and Response Toolkit
CHAP Hospice Standards of Excellence
CHAP Medication Reconciliation
CHAP Achieving Certification & Accreditation
When you receive your letter from CMS you'll want to do the following:
Step 1: Send us your PTAN (CCN). This should be located at the top of your letter from CMS
Step 2: Email us your Medicare Tie-In Letter & Complete the ebilling enrollment form
Complete the Additional Payer Source form to have additional payors added
- Once received and the information is processed, a biller will be assigned to your facility and provide you with the training link to schedule an overview of ebilling module. *Please be advise if anything is missing, or does not match you will be contacted by billing to provide the information required in order to avoid Medicare rejection.
*If you cannot locate your tie-in letter, an acceptable alternative is a print out of your 855A from PECOS: Welcome to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) (hhs.gov)
Step 3: Make sure you also have your FAC_ID (facility id). You will need this in order to export your HIS records from the EMR. If you do not have this contact CMS directly: 888-238-2122
Step 1: Ask the auditor for an email address they would like to use for their login. Please note: If they have surveyed another hospice that uses Hospice Tools as their EMR, they will need to provide a different email address.
Step 2: You will need edocs User Manager & Auditor Manager (located under System Access in user management) to create the auditor account, and to assign the patients & documentation they have requested to review.
Step 3: Proceed to create an account for the auditor in User Management. A system email will be sent from notifications-noreply@hospicetools.com with a temporary password.
Help Guide: Auditor Management
Eservices portal for Medicare if you are a Medicare Provider or Supplier, as it provides a secure, online platform to manage claims, check patient eligibility, view financial information, submit appeals, and receive electronic communications from your Medicare Administrative Contractor.
CMS has disabled access to certain beneficiary eligibility information through phone systems, using online portals like eServices is now a primary method for providers to verify patient eligibility. You will also have access to the Medicare Beneficiary Identifier (MBI) Lookup Tool.
Medicare Beneficiary Identifier (MBI) Lookup Tool:
PGBA: https://www.onlineproviderservices.com/ecx_improvev2/
CGS: https://www.cgsmedicare.com/myCGS/Index.html
NGS: https://www.ngsmedicare.com/NGS_LandingPage/Login
Help Guide:
Helpful Tips:
Who needs eServices- Medicare Providers and Suppliers: If you provide services to Medicare beneficiaries, you are likely a provider or supplier who would use this system.
Billing Agencies and Clearinghouses: These entities also use eServices to manage client Medicare information.
Why it's necessary now? Security Mandates: The Centers for Medicare & Medicaid Services (CMS) requires providers to use secure online portals like eServices to verify eligibility.
Increased Security: The system uses multi-factor authentication (MFA) to add an extra layer of security to your account and protect sensitive Medicare data.
Paperless Workflow: eServices allows for more efficient and paperless submission of forms, documents, and payments. To use the Medicare Beneficiary Identifier (MBI) Lookup tool in eServices, first log in to the eServices portal. Then, navigate to the MBI LOOKUP tab and enter the required fields: the beneficiary's last name, first name, date of birth, and Social Security Number (in the XXX-XX-XXXX format).
Select the "I'M NOT A ROBOT" checkbox and click SUBMIT INQUIRY to see the result.
Important Information Prerequisite: You must be registered for eServices to use this feature.
Data requirements: You need the beneficiary's first name, last name, date of birth, and Social Security Number to perform the lookup.
Troubleshooting: If your MBI lookup is unsuccessful, eServices will display an error message to guide you in correcting any blank or improperly formatted fields.
In an effort to better manage your account more closely to reflect the expected reimbursement amount, we would like to ask/remind you to please enter the last known reported hospice cert period in the Prior Hospice Day Count in eBilling for any patients you admit that have previously reported periods on the Medicare CWF (for any patient that is admitted/transferred to you in a period beyond a 1st 90).
The purpose of entering this information is to help close the gap on your expected paid amounts and your actual paid amount.
This means that when your payment is posted, the remaining write-off amount will be much lower than what is currently on your AR report.
For example: You are paid at a higher rate based on where the patient is on a specific day in their current cert period. This will help point the system to the more accurate rate of reimbursement.
How to add in eBilling:
Step 1: Click into eBilling. From the patient's chart select the General Tab
Step 2: Click the calendar box to enter the start date of the last reported period & the end date or transferred to your hospice date
The dates needed can be found on the bottom of the Patient Eligibility Report:
Hospice Durable Medical Equipment (DME) is billed by a supplier to the hospice agency, not directly to Medicare.
The hospice agency is responsible for paying the supplier for all equipment related to the patient's terminal illness, as this cost is covered by the daily hospice payment it receives from Medicare. The daily per diem rate the hospice receives from Medicare is intended to cover all costs, including DME related to the terminal illness.
Durable Medical Equipment, Oxygen, Etc. The hospice pays for all durable medical equipment (DME), prosthetics, orthotics, and supplies while the patient is in the hospice program.
Medicare Part B is responsible only if the item was prescribed for a diagnosis completely unrelated to the terminal illness. This is true even when the patient was renting equipment or purchasing supplies prior to the hospice coverage.
Helpful Resources:
https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c20.pdf
It depends on the situation of the payer change for the patient.
If a complete change in payer source is happening for the whole admission, then you can change their payer source in the patient’s financial tab in their chart in eDocs.
When the payer source is changed this way, the claims will need to be re-ran in ebilling to show this change.
If the patient’s payer source is changing for a specific timeframe they are on service, then you will need to discharge the patient. You would discharge the patient the day before the new payer source starts, then readmit them the next day.
This will require all new admission paperwork.
Discharging the patient triggers a new NOE (Notice of Election) to match the new admission date and show the payer source change.
To add a payer source in the patient’s chart under the Financial Tab, you will need to be contracted with that insurance and complete the Payer Request Form: https://form.asana.com/?k=7hIWyZAiPohqK9oHI67TRA&d=1202738877182513
Discharge & Readmit on Intake: https://drive.google.com/file/d/19TRpnyolqaKCrT7SlDkViocmUPQMdoUS/view
Add Financials & Run Eligibility:
Patient Financials / Charity Care:
https://www.dhcs.ca.gov/services/medi-cal/Pages/Hospice-Information.aspx
Medi-Cal Hospice Program Election Notice
Additional Information Contact:
Attn: Hospice Clerk
Department of Health Care Services
Medi-Cal Eligibility Division, MS 4607
1501 Capitol Avenue, Room 4063- P.O Box 997417-7417
Sacramento, CA 95899-7417
Email:
A change in primary payer requires a discharge & readmit along with new clinical legal paperwork, due to the listed Medicare rules and regulations.
*It is imperative that the Provider set the appropriate primary payer upon admit, failure to do so could result in loss of revenue.
Payers expect the Provider to determine the correct payer source upon admit and not having the correct payer that results in a late NOE or failure to obtain an authorization is not an acceptable appealable reason.
The date on your hospice paperwork must match the NOE (Notice of Election) start date because it establishes the effective date of your hospice benefit period. This ensures that Medicare coverage for hospice care is accurate and aligns with the patient's enrolment
Medicare Claims Processing Manual Chapter 11-Processing Hospice Claims
Explanation/Definitions:
Notice of Election (NOE):The NOE is a form submitted to Medicare and other payers (like CCA) when a patient chooses to enroll in hospice care.
Benefit Period: The NOE establishes the start date of your hospice benefit period, which is the period for which hospice care is covered.
Timely Filing: The NOE must be filed within a certain timeframe after the patient's admission date to Medicare. For out-of-network providers, this is generally within 5 business days; for in-network providers, it's within 7 business days.
Coordinated Dates: The date on your admission paperwork, which is the date you are admitted to hospice care, must match the start date of your benefit period as reported on the NOE. This ensures that Medicare is aware of the exact period for which they are responsible for coverage.
Medicare Coverage: If there is a discrepancy between the admission date and the NOE start date, it can lead to issues with Medicare billing and coverage. Medicare may not cover care from the date of admission until the NOE's start date is accepted, potentially resulting in a provider liability.
In essence, the matching dates ensure that Medicare and other payers understand the official start date of your hospice benefit and can process claims correctly.
Your Admit/SOC Date must match the start date on your authorization/NOE, which ties back to your legal admit paperwork/date signed.
For a Medicare hospice admission, a timely-filed Notice of Election (NOE) must be submitted within 5 calendar days of the hospice admission date.
The NOE starts the hospice benefit period and is typically submitted after the beneficiary signs the election statement. If the NOE is not timely filed, Medicare may not cover care from the admission date until the NOE is accepted.
Help Guide:
Exporting of documentation can be done individually or in bulk and can be downloaded as a PDF or directly sent to your hospice tools email.
1. Click into a patient's chart
2. Click edocs tab & click the Export Chart Button
Help Guide:
Missed visits should be documented using the applicable missed visit note located in the Hospice Tools EMR according to the specific discipline.
1. Identify the date of the missed visit at the top of the document
2. Document what occurred in the provided Reason for missed visit
3. Click Sign & Submit
Applicable Reports:
Help Guides:
Calendar: Completed and Missed Visits
418.113 Conditions of Participation: Emergency Preparedness
The hospice must comply with applicable Federal, State, and local emergency preparedness requirements. The hospice must establish and maintain an emergency preparedness program that must include, but not limited to, the following requirements:
Resources:
eCFR :: 42 CFR 418.113 -- Condition of participation: Emergency preparedness.
SOM Appendix Z-Emergency Preparedness
Document Recommendation: There is a emergency template that should be included in your EMR. If you do not have this or would like this added please email support@hospicetools.com
The original author of the document should click into the document and click MORE and then Request Deletion. A reason will need to be provided and then approved by either the Administrator, DCS or Regional Nurse.
Please note: The EMR randomly decides who the request will be sent to. However, if you are the DCS and requesting the deletion you cannot approve your own request it will default to the Admin or Regional Nurse's dashboard for approval
Help Guide: Document Deletion
You can amend and correct the document and select an alternative employee for signature. Make sure the employee is qualified to do so within their scope of practice.
*Signatures cannot be deleted from documentation. If you need to remove a signature the document will need to be redone entirely.
Help Guide: Amending & Correcting Documents for Signature
To add, edit, move, or delete events in the calendar you'll need Schedule Admin in user management in order to make adjustments for yourself and other team members. This is located under system access. Contact your agency's internal head administrator to adjust your user management permissions.
Hospice Tools is not responsible for managing your employees system permissions.
Help Guides:
You can assign a document to yourself or any discipline for use for a specific event(s) via the calendar. This feature will only work for events in the future, not for same day events. You can assign more than one employee a document or more than one document for one employee.
* As this time the calendar does NOT allow you to access the document from the calendar. The calendar will show you when the document associated with the event type has been completed, this is indicated by a green check mark in the upper right hand corner of the event. Click into the completed event and scroll to the bottom to view the completed documentation.
Help Guide: Calendar Document Creation
Help Guide: https://www.hospicetools.com/wp-content/uploads/2019/10/Discharge-Readmit-Hospice-R1.pdf
How-To Video: https://supportcenter.hospicetools.com/hc/en-us/articles/21204711583003-Patient-Readmit-Process
Documents can be uploaded into patient's chart as long as they are in PDF format.
Help Guide: Uploading Documentation
- Click into the patient's chart and select the vertical ellipses.
- Select Request Delete Patient. A reason will need to be provided.
- This deletion request will be sent to the Admin, DCS, or Regional Nurses' dashboard for approval.
*If there is any documentation in the chart, it will need to be deleted before the system will allow the deletion. Hospice Tools is not responsible for deleting patients or any clinical documentation.
Help guide: Deleting Patients
The original author of the document should click into the document and click MORE and then Request Deletion. A reason will need to be provided and then approved by either the Administrator, DCS, or Regional Nurse.
Please note: The EMR randomly decides who the request will be sent to. However, if you are the DCS and requesting the deletion, you cannot approve your own request it will default to the Admin or Regional Nurse's dashboard for approval. Hospice Tools is not responsible for deleting documentation or patients.
Help Guide: Document Deletion Request
A homemaker or hospice aide services or both may be covered on a 24-hour continuous basis during periods of crisis, but the care must be predominantly nursing care. The purpose of continuous home care is to achieve palliation and management of acute medical symptoms. Continuous home care is only furnished during brief periods of crisis as described in Sec. 418.204(a) and only as necessary to maintain the terminally ill patient at home.
To document CHC in Hospice Tools use the CHC documentation provided within the Nurse Chart section of the EMR.
Suggested Work Flow:
- Complete a Change in Level of Care form: to document that the patient transitioned from one level of care to another, this will also establish the official date in which the level of care changed. The Change in level of care form will go to internal MD for signature via the dashboard
- Update the Level of Care on the Patient's Intake Screen: The patient's level of care should be immediately updated on the intake screen. ex: If the patient was a Routine Home Care, update to Continuous Home Care)
- Recommended Documentation for CHC:
• Recommend process for documentation at least hourly
• Reason for continuous home care
• Vital signs (as appropriate)
• Observations of the patient’s condition
• Interventions used to achieve palliation of physical or emotional symptoms
• Services provided to the patient
• Medications given and the patient’s response
• Treatments completed and the patient’s response
• Contacts made to the hospice and/or attending physician
• New or changed orders received
• Family response to care (as indicated)
• Detailed discharge planning to transfer the patient back to routine home care as soon as the
crisis subsides.
• There is no specified frequency of documentation for CHC in the regulations or guidance. However, since CHC is for acute symptom management or some other crisis and billing occurs in15-minute increments, the best practice standard is to document at least every hour.
• Suggest an MAR and narcotic count at each nursing staff shift change
Hospice Tools Documentation for CHC:
- Continuous Initiation sheet: This document is used to provide specific details such as co-morbidities, team members assigned, state of crises, & specific orders
- Continuous Care Specific Instructions :(this can be combined with the CHC Initiation sheet) email support@hospicetools.com for this document modification
- Continuous Care Flow Sheet: This is used to take the patient's vitals, (this can be combined with the Continuous Care Hourly Documentation) email support@hospicetools.com for this document modification
- Continuous Care Hourly Documentation: This should be completed every hour in which the patient is seen the RN,LVN,LPN, or Hospice Aides
* If the documentation is not assessable by the appropriate discipline please contact support to remove the nurse specific credential tie to the CHC documentation
Hospice Tools Billing:
In order to bill for CHC hours, the hours will need to be entered in the ebilling module on the Patient's General Tab. If you do not have access the ebilling module, this will need to be completed by the employee who has access.
- Click Patients, Find the patient. In the General tab scroll down to the to the level of care
- Click on CHC Hours Covered hyperlink- A side panel will appear to enter the hours and dates applicable. The dates and hours entered should match the documentation completed in edocs
Additional Resources
Help Guides:
GIP is intended to be a short-term intervention (similar to the duration of an acute hospital stay). However, GIP under the Medicare hospice benefit is not equivalent to a hospital level of care under the Medicare hospital benefit. The federal regulations, at §418.302(b)(4), also state GIP is “for pain control or acute or chronic symptom management which cannot be managing in other settings.” GIP may be initiated when other efforts to control symptoms are ineffective. There is no specified disease, condition, or symptom that qualifies a patient to receive GIP. Each patient and his or her symptoms will differ; GIP may be helpful to one patient and not to another with the same disease. GIP care carries specific requirements regarding where the services may be provided, as well as types and levels of staffing.
Suggested Work Flow Transitioning to GIP Level of Care:
- Complete a Change in Level of Care form: to document that the patient transitioned from one level of care to another, this will also establish the official date in which the level of care changed. The Change in level of care form will go to internal MD for signature via the dashboard
- Update the Patient's Location information in the Contact Tab: Patient's location is no longer their home. Update the address to reflect accurately where the patient is receiving their Inpatient Care eCFR :: 42 CFR Part 418 -- Hospice Care*GIP care cannot be provided in the home, in an assisted living facility, a hospice residential facility, or in a long-term care nursing facility (NF). These environments are not equipped to provide skilled nursing and medical care to manage an acute symptom crisis
- Update the Level of Care on the Patient's Intake Screen: The patient's level of care should be immediately updated on the intake screen. ex: If the patient was a Routine Home Care, update to General Inpatient Care)
- Charting in Hospice Tools: Complete the GIP Evaluation Assessment- This document is located within the nurse chart section. Documentation to support Admission to GIPLC: Complete to indicate the specific intervention necessary, symptom changes, psychological and social problems, patient/family teaching, immanent death, and additional information text box to indicate the reason this care cannot be provided in the home.
- GIP Nurse Visit Note: Used to document scheduled or PRN visits. Comprised of a physical assessment, wound assessment, medication dashboard, care plan dashboard, & discharge planning
- Medications: Update any current or submit new medication orders using the comfort kit, single medication form, or multiple medication form s
-
IDG Updates: Using the applicable discipline progress notes, nurses need to address symptom management, observations, medications initiated and changes in medications, other changes in treatment, etc. Other IDG members need to document what they see in terms of symptom management, patient and family coping, discharge planning discussions, options for returning to the routine home care or another level of care, etc. All IDG members should document to paint a complete picture of the patient, including the pain and symptoms not adequately managed and why GIP is necessary each day the patient receives this
level of care.
*Refer to the NHPCO GIP Inpatient Compliance Guide below on documentation during this specific level of care, including documentation pertaining to IDG
For more information: NHPCO General Inpatient Compliance Guide
Respite care is short-term inpatient care provided to the individual only when necessary to relieve the family members or other persons caring for the individual at home. Payment for respite care is for a maximum of 5 continuous days at a time including the date of admission but not counting the date of discharge.
To document Respite Care in Hospice Tools you can use the documentation specific to each discipline to chart for patient visits.
Suggested Work Flow:
-
Complete a Change in Level of Care form: to document that the patient transitioned from one level of care to another, this will also establish the official date in which the level of care changed. The Change in level of care form will go to internal MD for signature via the dashboard
- Update the Patient's Location within the Contact Tab (if applicable): If the patient's location is no longer their home, proceed to change the address of the location in which the patient is receiving their care ( Medicare Certified Inpatient hospice facility, contracted Medicare-certified Hospice or SNF which has 24 hour care).
- Update the Level of Care on the Patient's Intake Screen: The patient's level of care should be immediately updated on the intake screen. ex: If the patient was a Routine Home Care, update to Inpatient Respite Care)
- Documentation for Respite Care: A patient’s plan of care during an inpatient respite stay would be the same as if the patient were receiving care in their home. The established plan of care visit frequency is followed by the hospice interdisciplinary group (IDG) and the facility staff would give care that the caregiver would provide in the home setting.
- Complete a Change in Level of Care Form: Once the patient returns to their previous level of care, the change in level of care form should be completed again, the intake screen level of care, and contact tab(if applicable) should updated to reflect the effective date
For more information: NHPCO Respite Care Tip Sheet
An initial bereavement assessment is performed within the first 5 days of admission. The assessment is of the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment must be incorporated into the plan of care and considered in the bereavement plan of care.
Help Guides:
Bereavement CareGiver Contacts
Resources:
https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/section-418.54
HOPE will be available for testing in your environment July 2025
Stay Tuned for More HOPE Updates Soon!
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