Audit Series #3: Assessing Clinical Eligibility for Payment

Course overview

This webinar explores the role of pre-billing clinical record audits in supporting Medicare hospice payment eligibility. Participants will learn how to assess clinical documentation for evidence of terminal prognosis, apply Local Coverage Determination (LCD) guidelines, evaluate disease trajectories and hospice assessment tools, and identify the impact of comorbidities and secondary conditions on eligibility. The course also reviews clinical audit tool development, auditor training and validation, and best practices for determining documentation sufficiency before claims are submitted.