Prediction of terminal illness can be difficult for hospices. Local Coverage Determinations (LCDs) are guidelines developed by Medicare Administrative Contractors (MACs)—CGS, NGS, and Palmetto GBA—to assist hospices determine hospice eligibility. Although LCDs are not regulatory, the MACs use the LCD criteria in medical review. Therefore, hospice organizations are wise to follow the LCDs as much…
Prediction of terminal illness can be difficult for hospices. Local Coverage Determinations (LCDs) are guidelines developed by Medicare Administrative Contractors (MACs)—CGS, NGS, and Palmetto GBA—to assist hospices determine hospice eligibility. Although LCDs are not regulatory, the MACs use the LCD criteria in medical review. Therefore, hospice organizations are wise to follow the LCDs as much as possible and use the criteria for documentation of terminal illness. However, a patient who does not meet the LCD for a particular disease state is not automatically barred from being eligible for the hospice benefit. The physician—attending, medical director, and/or both—can cite clinical details supporting a prognosis of 6 months or less if the illness runs its normal course. Each patient should be evaluated with objectivity to ensure hospice services are available to those who qualify.
