Summary

The Face-to-Face (F2F) visit is a physician encounter with a patient who is recertifying in their 3rd or greater hospice benefit period to determine that the patient is (still) appropriate to be on hospice. As such, it is very similar in purpose/function to the re-cert notes we have been doing – with the added dimension of a face-to-face encounter by the physician. The key question to be answered is “Do I think this patient will die in the next 6 months if the illness runs its usual course?”

The patient does not necessarily need a “complete H&P” … we only need to collect as much information as we need to answer the question/issue of their ‘hospice appropriateness’. (helpful CGS information to assist in documenting decline here and here)

Dictate … 1-800-246-7602 …

There are 3 distinct elements of documentation …

– the clinic note (h&p, soap) itself

attestation … “I saw patient name on month/date/year/time in her home/nh/other

recertification note

from the regs describing recert note … “a brief narrative explanation of the clinical findings that supports a life expectancy of six months or less … reflect the patient’s individual clinical circumstances … synthesize the patient’s comprehensive medical information in order to compose a brief clinical justification narrative for admission to hospice … should not be a simple restatement of the medical record facts, but instead sets out the physician’s rationale, in a few sentences, as to how the facts justify the prognosis … it must include an explanation of why the clinical findings of the face to face encounter support a life expectancy of 6 months or less.”

[format for recert note] Based on my F2F visit, discussion with IDT, and review of the clinical records, this is a age/sex admitted date with diagnosis and comorbids. Summary of clinical statuspaint picturesummarize evidence of decline – clinical and functional. Patient is/continues to be appropriate for hospice with a life expectancy of less than 6 months if the terminal illness runs its normal course based on these and other findings documented in the clinical record.

[an example of a recert note] Based on my F2F visit, discussion with IDT and review of the clinical records, this is a 69 yo lady with senile dementia. She is having significant decline including the loss of ability to ambulate and increasing need for adl assistance. She sleeps more and needs more help with eating. She is/continues to be appropriate for hospice with a life expectancy of less than 6 months if the terminal illness runs its normal course based on these and other findings documented in the medical record.