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It explains the role of effective documentation in communications, patient safety, and continuity of care, with sections on electronic health record evaluation, interoperability requirements, registry functionality, and practitioner documentation. Guidance includes CMS policy expectations for CEHRT, risks monitored through registries, and billing-focused documentation elements for E/M services.",{"@graph":63,"@context":112},[64,80,95],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":46,"@type":70,"position":76},"https://docshare.wps.com/template/paper-templates/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/n-hp-co-grab-go-toolkit-nhpco-palliative-care-playbook-for-hospices-documentation/572292/",4,{"url":78,"name":59,"@type":81,"author":82,"headline":59,"publisher":85,"fileFormat":88,"inLanguage":57,"description":61,"dateModified":89,"datePublished":89,"encodingFormat":88,"isAccessibleForFree":90,"interactionStatistic":91},"DigitalDocument",{"name":83,"@type":84},"dbqoiu","Person",{"url":68,"name":86,"@type":87},"DocShare","Organization","application/pdf","2026-10-13",true,{"@type":92,"interactionType":93,"userInteractionCount":4},"InteractionCounter",{"@type":94},"ViewAction",{"@type":96,"mainEntity":97},"FAQPage",[98,104,108],{"name":99,"@type":100,"acceptedAnswer":101},"What functions does documentation serve in hospice palliative care programs?","Question",{"text":102,"@type":103},"Documentation supports communication, records care activities and outcomes (goals of care, care plan, assessment, interventions, and responses to treatment), enables reimbursement, and supports quality assurance and process improvement.","Answer",{"name":105,"@type":100,"acceptedAnswer":106},"How does the toolkit distinguish an EMR from an EHR?",{"text":107,"@type":103},"An electronic medical record (EMR) is typically used by a single site for documentation, while an electronic health record (EHR) is broader, using multi-site software suites across the care continuum and generally offering improved interoperability.",{"name":109,"@type":100,"acceptedAnswer":110},"What documentation and coding considerations apply to Medicare B fee-for-service billing?",{"text":111,"@type":103},"Under Medicare B FFS, billable palliative care team members are physicians and non-physician practitioners, with services billed under Evaluation and Management (E/M). Documentation must be medically necessary, accurate, and include E/M elements such as history and physical examination, with appropriate coding to support the rationale for services and treatments.","https://schema.org",{"og:url":78,"og:type":114,"og:title":59,"og:site_name":86,"og:description":61},"article",{"robots":116,"canonical":78},"index,follow",{"doc_id":118,"site_id":56},572292,1791926600,{"code":4,"msg":5,"data":121},{"doc_id":118,"user_id":122,"nickname":83,"user_avatar":123,"doc_module":9,"category_id":45,"category_name":46,"doc_title":59,"doc_description":61,"doc_content":124,"file_id":125,"file_url":126,"file_type":127,"file_size":128,"view_count":4,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":129,"language":130,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":131,"faqs":132,"seo_title":133,"seo_description":61,"update_tm":119,"read_time":134},3985747862462,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","N HP CO GRAB & GO TOOLKIT  \nNHPCO Palliative Care Playbook for Hospices  \nDocumentation  \nThis toolkit is part of NHPCO’s comprehensive Palliative Care Playbook that is available to members as a benefit of membership. Learn more about Community-Based Palliative Care [Resources at www. nhpco.org/palliativecare](Resources at www. nhpco.org/palliativecare).  \nNHP CO.ORG  \nDocumentation  \nTable of Contents  \nElectronic Health Record Evaluation 1  \nInteroperability 1  \nRegistries 1  \nPractitioner Documentation 1  \nZ-Codes 2  \nMerit-based Incentive Payment System (MIPS) and Advanced  \nAlternative Payment Models (APMs) 3  \nInterdisciplinary Documentation 3  \nStandard assessment tools 4  \nThe Care Plan 6  \nAdvance Care Planning, Advance Directives, and POST 7  \nConclusion 7  \nAppendix A: Samples of Electronic Documentation 7  \nAppendix B: Z-Codes 39  \nAppendix C: Assessment Tools Evaluation 48  \nAppendix D: Palliative Care Flowsheet 50  \nReferences and Links 53  \nNHP CO Palliative Care Play book for Hospices NHP CO.ORG | i  \nDocumentation  \nThere are multiple functions of documentation: communication, record of care (goals of care, care plan: assessment, interventions, response to treatment, etc.), reimbursement, quality assurance and process improvement. Effective documentation can improve the quality of care and patient safety. Effective documentation is comprehensive, accurate, timely, and accessible.  \nElectronic Health Record Evaluation  \nMost organizations use an electronic medical record to record documentation. There are a variety of vendors to choose from; some vendors focus solely on community-based services, such as home health and hospice care, others may focus on medical group practice documentation or hospital documentation. Single site focused electronic documentation software is typically called an electronic medical record. A few vendors have a comprehensive suite of products to cover care across the continuum, creating a multi-site electronic documentation software called an electronic health record which is more comprehensive. You are more apt to get program specific software from an EMR vendor; however, you get improved interoperability with an EHR.  \nInteroperability  \nThe Centers for Medicare and Medicaid (CMS) are encouraging interoperability between electronic documentation software to ensure the provider and consumer have access to the most accurate up-to-date information when adjusting treatmentsand making care decisions . Proposed and new rules for various CMS reimbursed health care programs require software that meets 2015 CEHRT. For example, a medical group cannot participate in an advanced Alternative Payment Model unless their documentation software meets 2015 CERHT. The recently announced CMS/CMMI new care models require 2015 CEHRT to participate. Programs are allowed a one-year waiver. Incentives to achieve interoperability have been granted to software vendors for hospitals and medical groups, but not to community-based program software vendors . CMS/CMMI are now calling for penalties for providers and programs that do not meet the 2015 CEHRT across health care. It is recommended to select a vendor that meets or is working to meet the 2015 CEHRT requirements. If you are providing palliative care services to patients that are part of a health system or an ACO, check with them about interoperability between your EMR and theirs .  \nRegistries  \nAn EMR can provide functionality to create a panel of palliative care patients, often called a patient registry. Using a registry can help with case management and care coordination. Many palliative care programs operate as a population health management solution. Health management requires an ability to monitor the risk level of the population. Risks can include risk for disease progression, risk for symptom progression, risk for decline in function, risk for emergency room use and hospitalization, and risk for mortality. Some vendors have software programs that ","cbCaiswMckyefe04","https://ap.wps.com/l/cbCaiswMckyefe04","pdf",696722,56,"English","# Electronic Health Record Evaluation\n# Interoperability\n# Registries\n# Practitioner Documentation\n# Z-Codes\n# Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs)\n# Interdisciplinary Documentation\n# Standard assessment tools\n# The Care Plan\n# Advance Care Planning, Advance Directives, and POST\n# Appendix A: Samples of Electronic Documentation\n# Appendix B: Z-Codes\n# Appendix C: Assessment Tools Evaluation\n# Appendix D: Palliative Care Flowsheet\n# References and Links","[{\"question\":\"What functions does documentation serve in hospice palliative care programs?\",\"answer\":\"Documentation supports communication, records care activities and outcomes (goals of care, care plan, assessment, interventions, and responses to treatment), enables reimbursement, and supports quality assurance and process improvement.\"},{\"question\":\"How does the toolkit distinguish an EMR from an EHR?\",\"answer\":\"An electronic medical record (EMR) is typically used by a single site for documentation, while an electronic health record (EHR) is broader, using multi-site software suites across the care continuum and generally offering improved interoperability.\"},{\"question\":\"What documentation and coding considerations apply to Medicare B fee-for-service billing?\",\"answer\":\"Under Medicare B FFS, billable palliative care team members are physicians and non-physician practitioners, with services billed under Evaluation and Management (E/M). Documentation must be medically necessary, accurate, and include E/M elements such as history and physical examination, with appropriate coding to support the rationale for services and treatments.\"}]","N HP CO GRAB & GO TOOLKIT - NHPCO Palliative Care Playbook for Hospices - Documentation | PDF",20]