Blank Nevada Fa 27 Template

Nevada Fa 27 - Usage Guidelines

After deciding hospice care is the best route for a loved one or client, you'll need to complete the Nevada FA-27 form promptly. This is essential for notifying the necessary parties involved in providing hospice care about the enrolment, any changes, or recertification. Understanding the process step by step can simplify what might initially seem overwhelming. Here's how to do it:

1. Collect all required documents: Certificate of terminal illness, election of hospice services, updated physician orders for recertification, PASRR screening, and LOC Determination Letter if the recipient will reside in a Nursing Facility.
2. Fill in the Submission Date section with the date you're sending the form.
3. Under Hospice Agency Information, provide the name, NPI (National Provider Identifier), address, phone number, and fax number of the hospice agency.
4. For Physician Information, enter the attending provider’s name, NPI, hospice physician's name, and their NPI.
5. In the Recipient Information section, detail the recipient's full name, address, recipient ID, Medicare ID (if applicable), date of birth, sex, phone number, marital status, and list other payors if any.
6. Under Notifications and Clinical Information, include the hospice diagnosis, ICD-9 codes, hospice enrollment date, recertification date, certification period, revocation date (if applicable), transfer date to a new facility, date of discharge to home, date of death, and answer questions regarding residency in a Nursing Facility and other services provided.
7. If the recipient resides in a Nursing Facility, complete the Nursing Facility Information section with the facility’s name, NPI, address, phone, and fax numbers, and indicate whether the recipient is in a Medicaid bed.
8. Finally, in the Submitter Information section, sign and date the form providing your contact information.
9. Fax the completed form along with all required attachments to (866) 480-9903.

After you have sent the form and all necessary documents, HP Enterprise Services will review the information to ensure everything is in order. They may reach out if they need more details or clarifications. Remember, timely submission within 72 hours is crucial to facilitate seamless hospice care arrangements. For any queries or concerns about the form or the process, contacting HP Enterprise Services at (800) 525-2395 can provide assistance and peace of mind during this critical time.

1. What is the purpose of the Nevada FA-27 form?

   The Nevada FA-27 form is designed for hospice agencies to notify HP Enterprise Services about the enrollment, discharge, change, or recertification of a hospice recipient. This notification helps manage and coordinate the necessary hospice services for Medicaid and Nevada Check Up recipients efficiently.

2. What information and documents are required to submit with the FA-27 form?

   When submitting the FA-27 form, a hospice agency must include several critical documents: a certificate of terminal illness, an election of hospice services document, and updated physician orders for recertification. Additionally, if the recipient resides or will reside in a Nursing Facility, a PASRR screening and LOC (Level of Care) Determination Letter are also required.

3. How and where do I send the completed Nevada FA-27 form?

   The completed FA-27 form, along with all necessary attachments, should be faxed to HP Enterprise Services at (866) 480-9903. It is important to ensure that all information is accurate and complete to avoid any delays in processing.

4. Who should I contact if I have questions about the FA-27 form?

   If you have any questions regarding the FA-27 form or the submission process, you can call HP Enterprise Services at (800) 525-2395. Representatives are available to provide assistance and answer any questions you may have.

5. What are the critical dates and periods mentioned in the FA-27 form?

   The form outlines several key dates related to hospice care, including the hospice enrollment date, recertification date, certification periods (1st 90 days, 2nd 90 days, 60 days), revocation date (when hospice care is discontinued), transfer date to a new facility, date of discharge to home while on hospice, and date of death. These dates help track the recipient's care history and ensure timely and appropriate hospice services.

6. Is it mandatory to notify if a hospice recipient is residing or will reside in a Nursing Facility?

   Yes, it is crucial to indicate whether the hospice recipient is residing or will reside in a Nursing Facility on the FA-27 form. This information is necessary for coordinating care, especially if Medicaid beds are involved. Additionally, the required PASRR screening and LOC Determination Letter must be attached if this is the case.

7. What should I do if hospice care or other services are being provided in conjunction with Personal Care Services (PCS) or Waiver Services?

   If the recipient receives Personal Care Services (PCS) or Waiver Services alongside hospice care, a completed Form FA-24A, "Care Coordination for Hospice and PCS or Waiver Services," must be submitted. This ensures that all services are properly coordinated to meet the recipient's needs without unnecessary overlap or duplication.

Filling out the Nevada FA-27 form, which is essential for notifying HP Enterprise Services about a hospice recipient’s enrollment, discharge change, or recertification, requires attention to detail. However, many people make mistakes during this process. Understanding these common errors can improve accuracy and efficiency in hospice care coordination.

Firstly, a frequent error involves incorrect or incomplete hospice agency information. The form requires detailed information about the hospice agency, including the name, National Provider Identifier (NPI), address, and contact details. Omitting any of this information or providing inaccurate details can delay processing.

Another common mistake is not attaching the required documents. The form mandates the inclusion of a certification of terminal illness, an election of hospice services, and updated physician orders for recertification. Additionally, for recipients in nursing facilities, a PASRR screening and a Level of Care (LOC) Determination Letter are needed. Failure to attach these documents can invalidate the submission.

Many also err by providing inaccurate recipient information. This section captures the recipient’s full name, address, recipient ID, Medicare ID (if applicable), date of birth, sex, marital status, and other payors. Inaccuracies here can lead to misidentification or benefit issues for the recipient.

1. Filling out the physician information incorrectly.
2. Forgetting to specify whether the recipient is currently residing in a nursing facility.
3. Leaving the notifications and clinical information section incomplete or incorrect.
4. Incorrectly completing the nursing facility information (when applicable).
5. Omitting the signature of the person completing the form, which is crucial for validation.

Mistakes in physician information also pose significant problems. This section requires the names and NPIs of both the attending provider and the hospice physician. Misinformation here can lead to complications in coordination and communication between healthcare providers.

Failure to correctly specify the recipient's current residing status—especially whether they are in a nursing facility—neglects necessary coordination of care. This oversight can affect the recipient's eligibility for certain services and delay the provision of appropriate hospice care.

• Double-checking all entered information for accuracy before submission.
• Ensuring all required documents are attached and up to date.
• Verifying the recipient’s information with the recipient or their guardian to prevent errors.
• Consulting with a healthcare professional for correct physician and clinical details.
• Reviewing the entire form for completeness and signatures before faxing.

By avoiding these common mistakes, individuals and hospice agencies can ensure their FA-27 submissions are accurate and complete, thus facilitating smooth and timely coordination of care for recipients. This diligence not only complifies with procedural requirements but also supports the provision of compassionate and effective hospice care.

The Nevada FA-27 form is a vital document for hospice agencies within the state, facilitating the seamless communication of enrollment, discharge, and changes regarding hospice care recipients with HP Enterprise Services. To ensure a comprehensive approach, several additional documents often accompany the FA-27 form, each playing a crucial role in the holistic management and provision of hospice care services. Here are descriptions of five such documents:

• Certificate of Terminal Illness: This document substantiates a patient's eligibility for hospice care by providing medical proof of a terminal diagnosis. It must be signed by both the attending physician and the hospice medical director, confirming the patient's life expectancy is six months or less if the disease follows its usual course.
• Election of Hospice Services: Through this form, a patient, or their designated representative, formally chooses to receive hospice care instead of standard curative treatment for their terminal illness. It marks an important decision in the patient’s care journey, outlining their consent and understanding of the hospice philosophy.
• Updated Physician Orders for Recertification: This document contains updated orders from the patient's physician, reflecting any changes in the hospice care plan. It is crucial for recertification periods to ensure the patient's care remains aligned with their current needs and wishes.
• PASRR Screening: For patients who reside or will reside in a nursing facility, the Pre-Admission Screening and Resident Review (PASRR) is a federal requirement to ensure that individuals are not inappropriately placed in nursing facilities for long-term care. It assesses whether a nursing facility is the most appropriate setting for the patient’s needs.
• LOC Determination Letter: The Level of Care (LOC) Determination Letter is a formal declaration establishing the patient's eligibility for nursing facility care or other long-term care services based on medical necessity. It supports the PASRR's findings by providing a detailed evaluation of the patient's care needs.

When these documents accompany the FA-27 form, they create a comprehensive packet that enhances the coordination, quality, and efficiency of hospice care provision. Each form contributes specific and necessary information, ensuring that patients receive care that is both appropriate to their condition and aligned with their personal wishes and needs.

The Nevada FA-27 form, designed for hospice notification in relation to Nevada Medicaid and Check Up, echoes the structure and purpose of several other healthcare and Medicaid-related documents. Key elements like the need for precise patient data, healthcare provider information, and specifics regarding the patient's condition and care requirements are common across such forms. Here are some examples:

Form CMS-855A is one example, primarily used for Medicare enrollment for institutional providers. Like the Nevada FA-27 form, CMS-855A collects detailed provider information, including the National Provider Identifier (NPI) and practice location. Both forms serve a gatekeeping role, ensuring that the entities providing care are appropriately recorded and authorized for billing with federal healthcare programs. However, CMS-855A is more focused on the provider's eligibility for Medicare billing, whereas the FA-27 zeroes in on a specific care scenario — hospice service notification.

Form HCFA-485, the Home Health Certification and Plan of Care, shares a similar audience and objective with the Nevada FA-27. It communicates essential care information, including diagnoses, treatment plans, and service orders, to support billing and coordination of home health services. Both forms require comprehensive clinical data, such as the patient’s medical condition, anticipated services, and certification of eligibility for the prescribed care. Yet, HCFA-485 is broader in scope, covering all types of home health services, not just hospice care. The FA-27 is specifically tailored to notify about hospice enrollment and changes, including the necessary documentation to support recertification.

The Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, also aligns with the Nevada FA-27 in its regulatory and administrative function within the healthcare continuum. The ABN is utilized to notify Medicare recipients of services Medicare might not cover, making the patient aware of potential out-of-pocket costs. Similarly, the FA-27 involves notifying and recording specific healthcare services (in this case, hospice) that impact coverage and costs. While the ABN is directly related to Medicare’s payment structure and informing beneficiaries, the FA-27 facilitates healthcare providers in communicating critical administrative and clinical changes to Medicaid services. It ensures all necessary documentation is in place for ongoing care management and billing.

When it comes to filling out the Nevada FA-27 form, it's crucial to approach the task with a fine balance of attentiveness and precision. This form plays a pivotal role in the process when a hospice agency needs to notify HP Enterprise Services about the enrollment, discharge change, or recertification of a hospice recipient. Here’s a straightforward guide on what to do and what not to do when completing this document.

• Ensure all required attachments are included with your submission, such as the certificate of terminal illness, the election of hospice services, and updated physician orders for recertification. If applicable, include the PASRR screening and LOC Determination Letter.

• Fax the form to HP Enterprise Services within the stipulated 72-hour timeframe for new or changed information to ensure timely processing.

• Verify the accuracy of all entered information, especially the NPI numbers, recipient ID, and Medicare ID, if applicable, to avoid unnecessary delays.

• Clearly indicate whether the recipient is currently residing in a Nursing Facility, as this requires additional documentation and affects the level of care coordination needed.

• Contact HP Enterprise Services for any questions or clarification needed before submitting the form to prevent errors.

• Sign and date the form as the submitter to authenticate the submission and confirm that the information is accurate and complete to the best of your knowledge.

• Overlook the need to attach additional documents required for the process. Each attachment plays a critical role in the recipient’s care and eligibility for hospice services.

• Delay beyond the 72-hour reporting window after a new enrollment, discharge change, or recertification as this can impact the recipient’s access to care and services.

• Enter information in haste, which could lead to mistakes or inaccuracies that could complicate the recipient’s hospice care services.

• Forget to check if the recipient resides in a Medicaid bed within a Nursing Facility, as this detail is crucial for proper service coordination and billing.

• Assume that all aspects of the form are self-explanatory. If there’s any doubt or confusion, reaching out to HP Enterprise Services can provide needed clarity and guidance.

• Submit the form without a signature, as an unsigned form may be considered incomplete and could delay processing times.

By following these guidelines, the process of completing and submitting the Nevada FA-27 form can be smooth and efficient, ensuring that hospice recipients receive the proper care and services without unnecessary delay.