Quick Reference Card
Referral-to-Admission Workflow
Role-mapped steps aligned to Medicare regulatory requirements
Role-mapped steps aligned to Medicare regulatory requirements
| Step | Action | Regulatory Link |
|---|---|---|
| 1.1 | Receive referral; log timestamp and source; capture patient name, DOB, location, contact, referring provider | Operational - creates audit trail |
| 1.2 | Confirm Medicare Part A eligibility (HIC number, coverage period, traditional vs. MA) | 42 CFR 418.20 |
| 1.3 | Identify primary terminal diagnosis; obtain clinical records (H&P, discharge summary) | 42 CFR 418.22(b) - cert narrative support |
| 1.4 | Classify: (a) eligible - proceed; (b) MA - escalate; (c) insufficient info - request records before sending clinician | 42 CFR 418.20; 418.22 |
| Step | Action | Regulatory Link |
|---|---|---|
| 2.1 | On-site evaluation: clinical status, function, symptom burden, environment, caregiver capacity, medication list | 42 CFR 418.22(b)(3); 418.54(b) |
| 2.2 | Assess prognosis vs. 6-month standard; escalate to medical director if unclear | 42 CFR 418.3; 418.22(b)(1) |
| 2.3 | Medical director provides formal recommendation to admit or not admit - documented in record | 42 CFR 418.25 |
| Step | Action | Regulatory Link |
|---|---|---|
| 3.1 | Discuss hospice benefit: palliative nature, waiver of curative services, attending physician selection, BFCC-QIO | 42 CFR 418.24(b) |
| 3.2 | Execute election statement: verify all elements; effective date ≥ signature date | 42 CFR 418.24(b),(e) |
| 3.3 | Initiate addendum process if non-covered items identified | 42 CFR 418.24(c)–(d) |
| 3.4 | Execute certification: patient-specific narrative; correct signatory for benefit period | 42 CFR 418.22(b); 418.22(a)(1) |
| 3.5 | F2F attestation (3rd+ periods): hospice physician or NP; encounter date + signature + signature date | 42 CFR 418.22(a)(4); FY 2026 |
| 3.6 | Submit NOE to MAC - target same-day; confirm acceptance by Day 5 | 42 CFR 418.24(e) |
| Step | Action | Regulatory Link |
|---|---|---|
| 4.1 | Schedule initial assessment for Day 0 or Day 1 - never past 48-hour window | 42 CFR 418.54(a); SOM L522 |
| 4.2 | At start of visit, before any clinical task: deliver patient rights verbally + in writing; obtain signature | 42 CFR 418.52(a) |
| 4.3 | Complete initial assessment: immediate needs, symptoms, safety, caregiver, medications, urgent interventions | 42 CFR 418.54(a); SOM L524, L525 |
| 4.4 | Notify IDG; assign all 7 domain leads; schedule comprehensive assessment completion by Day 5 | 42 CFR 418.54(b); 418.56(a) |
| 5.1 | IDG completes all 7 domains by Day 5 (physical, psychosocial, emotional, spiritual, drug, bereavement, safety) | 42 CFR 418.54(b)(1)–(7) |
| 5.3 | Develop individualized POC from assessment findings; attending physician review and sign | 42 CFR 418.56(b); MBPM |
| 5.5 | File signed POC, assessment, election statement, certification, NOE confirmation, and rights acknowledgement | 42 CFR 418.104(b); SOM L673–L676 |