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Provider Notice issued 05/14/07
Separate Forms for Notification of Initial Election Period; Continuing Benefit Period and Recertification of Terminal Illness; and Patient Discharge
| To: | Participating Hospice Providers |
| Date: | June 10, 2016 |
| Re: | Separate Forms for Notification of Initial Election Period; Continuing Benefit Period and Recertification of Terminal Illness; and Patient Discharge |
In an Informational Notice dated April 7, 2014, the Department announced the release of a standardized form, the HFS 1592, to be used by hospice providers to notify the Department of a patient’s election or discharge from hospice care. As a response to feedback from providers, the Department is revising the HFS 1592 as an initial election form, and has developed two separate forms, for notification of continuing benefit periods/recertification of terminal illness, and patient discharge.
· HFS 1592 – Formerly identified as the Notification to HFS of Illinois Medicaid Hospice Benefit Election, this form has been revised as the Notification to HFS of Illinois Medicaid Hospice Benefit – Initial Election Period. It will be used only to notify the Department of a patient’s initial election period. It also includes a reminder to attach a copy of the physician certification of terminal illness statement that corresponds to the initial election period noted.
· HFS 1593 – Notification to HFS of Illinois Medicaid Hospice Benefit – Continuing Benefit Period and Recertification of Terminal Illness. This new form is to be used to notify the Department of a patient’s continuing hospice benefit period, and includes a reminder to attach a copy of the physician certification of terminal illness statement that corresponds to the continuing benefit period noted.
· HFS 1594 – Notification to HFS of Patient Discharge from Hospice Care. This new form is to be completed only when a patient discharges from hospice care, and the provider must identify the specific discharge reason.
All of the forms above have a date of 02-16 in the bottom left corner of the form, and are available in a PDF-fillable format on the Department’s Medical Forms page. Please begin using these versions immediately.
Any questions regarding this notice may be directed to a hospice billing consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565.
Felicia F. Norwood
Director
Provider Notice issued 06/10/16
Separate Forms for Notification of Initial Election Period; Continuing Benefit Period and Recertification of Terminal Illness; and Patient Discharge
| To: | Participating Hospice Providers |
| Date: | June 10, 2016 |
| Re: | Separate Forms for Notification of Initial Election Period; Continuing Benefit Period and Recertification of Terminal Illness; and Patient Discharge |
In an Informational Notice dated April 7, 2014, the Department announced the release of a standardized form, the HFS 1592, to be used by hospice providers to notify the Department of a patient’s election or discharge from hospice care. As a response to feedback from providers, the Department is revising the HFS 1592 as an initial election form, and has developed two separate forms, for notification of continuing benefit periods/recertification of terminal illness, and patient discharge.
· HFS 1592 – Formerly identified as the Notification to HFS of Illinois Medicaid Hospice Benefit Election, this form has been revised as the Notification to HFS of Illinois Medicaid Hospice Benefit – Initial Election Period. It will be used only to notify the Department of a patient’s initial election period. It also includes a reminder to attach a copy of the physician certification of terminal illness statement that corresponds to the initial election period noted.
· HFS 1593 – Notification to HFS of Illinois Medicaid Hospice Benefit – Continuing Benefit Period and Recertification of Terminal Illness. This new form is to be used to notify the Department of a patient’s continuing hospice benefit period, and includes a reminder to attach a copy of the physician certification of terminal illness statement that corresponds to the continuing benefit period noted.
· HFS 1594 – Notification to HFS of Patient Discharge from Hospice Care. This new form is to be completed only when a patient discharges from hospice care, and the provider must identify the specific discharge reason.
All of the forms above have a date of 02-16 in the bottom left corner of the form, and are available in a PDF-fillable format on the Department’s Medical Forms page. Please begin using these versions immediately.
Any questions regarding this notice may be directed to a hospice billing consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565.
Felicia F. Norwood
Director