[4043] Hospice Eligibility & Prognosis | Getting It Right from Day One
This program provides a clinical compliance roadmap for defensible eligibility determination, prognosis documentation, and LCD alignment across high risk diagnoses such as cancer, dementia, heart failure, COPD, and debility/FTT.
Presentation Info:
- TAHC&H Event | 57th Annual Meeting | Rich-Media Presentation Capture | Online On-Demand Access
- Presentation Date: September 2nd, 2026
Program Description:
Medicare spends $27.5 billion a year on hospice care -- and federal auditors are scrutinizing every claim. With the OIG elevating hospice eligibility as a top oversight priority and ZPIC/RAC reviews intensifying in Texas, agencies cannot afford inconsistent or informal eligibility decisions. Errors now carry real consequences: recoupments, payment suspension, loss of Medicare certification, and reputational damage.
This program provides a clinical compliance roadmap for defensible eligibility determination, prognosis documentation, and LCD alignment across high risk diagnoses such as cancer, dementia, heart failure, COPD, and debility/FTT. You will learn what auditors look for, where documentation breaks down, and how to build internal safeguards that protect patients and the agency. It also covers the October 2025 rollout of the HOPE tool, which raises expectations for structured documentation and prognosis substantiation. Eligibility integrity isn’t paperwork — it’s a patient safety and agency survival issue!
HCSSA Topic(s) Addressed:
- §558.259[c][2]information on the state and federal laws applicable to an agency
- §558.259[d][4] agency responsibilities
- §558.260[a][3] basic principles of management in a licensed health-related setting
- §558.260[a][6]risk assessment and management
- §558.260[a][7]financial management
Education-Training Credits:
- TX HCSSA Administrator/Alternate Continuing Education
- Continuing Education for Nurses
- 1.0 Contact Hr(s)
- This program awards CNE until 09.02.2028
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
Nurse CE Approval Statement
Texas Association for Home Care & Hospice is an approved provider of continuing nursing education by Louisiana State Nurses Association,
an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. LSNA Provider No. 4002151
Requirements for Successful Completion:
To receive continuing education credits for this online presentation, the participant must view the entire online presentation, complete an evaluation, and post-test attestation.
Reporting of Perceived Bias:
Bias, as defined by the American Nurses Credentialing Center's Commission on Accreditation (ANCC COA/LSNA) is the tendency or inclination to cause partiality, favoritism, or influence.
Commercial bias may occur when a CNE activity promotes one or more product(s) (drugs, devices, services, software, hardware, etc.). This definition is not all inclusive and participants
may use their own interpretation in deciding if a presentation is biased. The ANCC COA is interested in the opinions and perceptions of participants at approved CNE activities,
especially in the presence of actual or perceived bias in continuing education. Therefore, ANCC invites participants to access their ANCC Accreditation Feedback Line to report any noted
bias or conflict of interest in the education activity.
The toll-free number is 1(866) 262-9730.
TAHC&H Faculty/Presenter(s):
Colleen Woods, MSNEd, RN, Chief Consulting Officer, Lead Educator, JCC Texas
About the Presenter(s): Colleen Woods
Colleen Woods, MSNEd, RN, is a Senior Consultant and Lead Educator with JCC Consulting in North Texas. She has worked in home health and hospice since 1996, serving in roles including field nurse, case manager, educator, QA manager, Director of Nursing, and Administrator. Since joining JCC Consulting in 2011, she has led the firm’s educational department as its primary nurse planner and presenter.
Colleen regularly speaks on topics related to home care and hospice operations, compliance, and staff training. She focuses on helping agency leaders implement practical changes that support high-quality care and meet regulatory requirements.
She earned her Master of Science in Nursing Education from Texas Woman’s University and her Bachelor of Science in Nursing from the University of Texas at Arlington.
[4043] Hospice Eligibility & Prognosis | Getting It Right from Day One
