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…
Tag: hospice
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…
State Operations Manual (SOM) for Hospice – Appendix M and subsequent revisions to the Hospice Basic Surveyor Training
On January 27, 2023, the Centers for Medicare and Medicaid Services (CMS) released Memo# QSO-23-08-HOSPICE related to revisions in the State Operations Manual (SOM) for Hospice – Appendix M and subsequent revisions to the Hospice Basic Surveyor Training. These revisions take effect immediately and are related to the focus by CMS on the quality of…
Hospice Final Rule Implementation
Just over the horizon, October and everything pumpkin is approaching. This means the implementation of the hospice final rule for FY 2023–beginning on October 1st. This year’s final rule includes a rate increase of 3.8% for those hospices who submit required quality data. For those who don’t comply, a 2% payment penalty is assessed to…
