1.Describe prognostic criteria for determining hospice eligibility, as defined by the various Medicare Administrative Contractors' Local Coverage Determinations.2.Describe incorporating these criteria into key elements needed for optimally documenting hospice eligibility, as derived from feedback from an ongoing, multi-state performance improvement effort.3.Discuss effective techniques for modifying clinician behavior to improve documentation as well as potential pitfalls and hazards of not continuously monitoring documentation performance. Determining prognosis is an integral function for clinicians involved in hospice and palliative medicine. Because the Medicare Hospice Benefit defines hospice eligibility in terms of prognosis, proper and optimal documentation of this by clinicians is vital both for clinical accuracy and for financial viability of the hospice program. We will describe our 3-year, ongoing experience involving more than 450 hospice medical directors (HMDs) in 31 states across all four of the Medicare Administrative Contractors and their respective, different Local Coverage Determinations. In an ongoing fashion, we determine our internal performance, which is compared to published standards and to other non-published feedback from the multiple regulatory auditing entities. Because of our size, we are virtually always undergoing external reviews somewhere across our organization. This information has led to key elements being identified and recommended for optimal documentation. By using standard performance improvement techniques, education and feedback is provided to HMDs and other hospice clinicians regarding both clinical standards as well as documentation methods. This presentation will describe the techniques found to be most effective in modifying clinician behavior to improve documentation. We will also describe processes for minimizing and clarifying potentially contradictory documentation elements across time or among different clinicians. Results of our effort have substantially improved internal compliance scores as well as resulting in significantly better external regulatory audit findings. The key elements, processes, and forms used for our project will all be shared.