Hospice providers continue to be under high scrutiny for their use of General Inpatient (GIP) care. As audits increase, strict compliance is essential to avoid financial penalties and ensure quality patient care. The Heightened Regulatory Landscape A 2016 Office of Inspector General (OIG) study found that 31% of GIP claims were billed inappropriately, leading to…
Tag: hospice
Celebrate National Care at Home Month
November 2024 marks a new chapter for the home care community, introducing National Care at Home Month. This celebration unites two powerhouse organizations, the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO), under the National Alliance for Care at Home. Together, these organizations represent an extensive…
Expanded Hospice Oversight
The U.S. Centers for Medicare & Medicaid Services (CMS) will expand its enhanced oversight for new hospices in California, Nevada, Arizona, and Texas to combat fraud, waste, and abuse. This includes prepayment medical reviews of claims before payment by Medicare Administrative Contractors (MACs). Initial review volumes will be low and adjusted based on compliance, but…
Balancing Innovation with Robust Security in Hospice Care
The integration of technology into end-of-life care is revolutionizing hospice services, bringing both significant opportunities and complex challenges. On one hand, advancements such as artificial intelligence (AI), predictive analytics, and telehealth have greatly enhanced care delivery, streamlined operations, and improved both patient outcomes and staff satisfaction. On the other hand, these innovations have introduced new…
Hospice CARE Act Set To Reform Hospice
Rep. Earl Blumenauer (D-Oregon) announced draft legislation, the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, on June 13, 2024, aiming for transformative reforms to hospice payment systems and regulatory oversight. The hope is to be introduce the bill in Congress later in 2024. A key element of the Hospice CARE Act is the…
Challenges In Providing Continuous Home Care To Hospice Patients
The Medicare Hospice Benefit affords patients four levels of care to meet their needs: routine home care, respite care, general inpatient care (GIP), and continuous home care (CHC). For hospice providers, the majority of Medicare days of care were at the routine home care level of care for both percent of payments made and percent…
Hospice Care: Extended Length of Stay: Medical Necessity and Documentation Requirements
In December 2023, Performant, the designated Recovery Audit Contractor (RAC) for the Centers for Medicare and Medicaid Services (CMS), introduced a new issue, Issue 0221 – Hospice Care: Extended Length of Stay: Medical Necessity and Documentation Requirements, to its approved list. This newly added issue centers on evaluating the “Extended Length of Stay” to verify medical…
Self-Determined Hospice Cap (SDHC) Report
Due Now: Credit Balance Reporting now due for the Quarter ending 9/30/2023regardless of whether any credits need to be reported. What to Submit: The one-page Credit Balance Report – Form CMS-838. Ensure that it is signed by an authorized representative. It may be necessary to submit additional Credit Balance Report Detail pages. When To Submit: …
Hospice Surveys & Complaints
When is the last time you entered a complaint in your grievance log? One of the core standards of focus for hospice surveyors is §418.52(b)-Exercise of rights and respect for property and person. The interpretive guidelines for this standard state that a “grievance is a formal or informal written or verbal complaint made to any…
Public Health Emergency and Hospice
The end of the COVID-19 Public Health Emergency on May 11th requires hospice organizations to examine their current practices. The waivers and flexibilities put into place to ease burdens on hospices will be coming to an end. To avoid survey deficiencies, it’s important to know when compliance to the affected Conditions of Participation is expected. A…
