Hospice News

SEPTEMBER 15, 2022

A coalition of hospice and palliative care industry groups has urged lawmakers to make billing codes for telehealth available on Medicare hospice claim forms. Centers for Medicare & Medicaid Services (CMS) to develop and implement Healthcare Common Procedure Coding System (HCPCS) codes or modifiers for telehealth visits. .

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Hospice Nurse Hero

FEBRUARY 15, 2024

One of these skills is understanding and completing hospice GIP documentation. In this article, we’ll explore why you need to learn General Inpatient (GIP) documentation and explore patient scenarios where GIP might be necessary. GIP care must be provided in a Medicare-certified hospice inpatient facility or a hospital.

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Hospice News

APRIL 17, 2024

Centers for Medicare & Medicaid Services’ (CMS) review and appeals process, according to CEO Greg Hagfors. The provider recently celebrated the 45th anniversary of its founding, which preceded the establishment of the Medicare Hospice Benefit. Department of Health and Human Services (HHS) due to audit-related claims denials.

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Hospice News

APRIL 12, 2024

Centers for Medicare & Medicaid Services’ (CMS) proposed 2025 hospice rule contains clarifications on which physicians may certify patients for hospice enrollment. However, federal regulations are inconsistent as to which physicians can certify a patient as being terminally ill under Medicare.”

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Hospice News

OCTOBER 19, 2023

A Medicare Administrative Contractor (MAC) can deny a hospice claim for a wide range of reasons, but two types of errors stand out that can lead to a rejection. Medicare’s automated claims processing systems are designed to identify these kinds of errors. A few causes of denials are widely known.

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Hospice Nurse Hero

JANUARY 4, 2024

In this guide, we’ll explore tips and strategies, suitable for both seasoned and new nurses, to enhance your hospice documentation process. The struggle I see most often is that hospice documentation is complex, and involves a form of charting known as “negative charting” that most nurses are not familiar with.

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Hospice News

JULY 17, 2023

Centers for Medicare & Medicaid Services (CMS) is conducting a small pilot program for post-payment reviews of hospice stays that exceed 90 days. The SMRC will notify hospices under review with a statement of reasons, request for documentation as well as informational resources. billion, a rate of 12%, Noridian indicated.

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Hospice News

FEBRUARY 22, 2024

If the government wants to go in and take documents, [that’s] a different issue and a lot more complex. In some cases, hospices’ Medicare certification have been revoked, while others have been barred from practicing in the industry. “The vast majority of criminal cases are going to plead out. It’s a longer conversation.”

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Nurse.com

JULY 11, 2022

The RN did the assessment and documented her results. The resident was found deceased on the floor the next day, and the RN was asked to change her documentation of her assessment. The administrator had another RN change the documentation done initially by the RN in question. The report was denied by the organization.

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Hospice News

JULY 7, 2023

Hospices need to have solid documentation to demonstrate a patient’s need for general inpatient care (GIP) as regulatory oversight zeroes in on those services. Both types of audits focus on identifying recurrent errors on Medicare claims or billing practices that the the U.S. GIP can involve longer stays and higher costs.

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Hospice News

OCTOBER 27, 2023

Auditing types anticipated to ramp up in hospice include Targeted Probe and Educate (TPE) audits conducted by Medicare Administrative Contractors (MACS) and others involving Unified Program Integrity Contractors (UPIC), Supplemental Medical Review Contractors (SMRC) and Recovery Audit Contractors (RAC). Some of them are easy to digest.

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Hospice News

OCTOBER 16, 2023

Centers for Medicare & Medicaid Services’ (CMS) updated risk adjustment policy could lead to tightened belts — or a golden opportunity — for palliative care providers in Medicare Advantage. patients is now reimbursed through risk-based models like Medicare Advantage and Accountable Care Organizations (ACOs).

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Hospice News

FEBRUARY 2, 2024

Centers for Medicare & Medicaid Services (CMS). Medicare may cover CHC for as long as 24 hours a day. Claims and documentation for these services are frequently flagged for audits or medical reviews. Each day, a patient in CHC must receive a minimum of 8 hours of nursing care or nursing and aide care.

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Hospice News

APRIL 8, 2024

Centers for Medicare & Medicaid Services’ (CMS) 2025 proposed hospice rule contained requests for information (RFIs) that could signal changes in the agency’s thinking on key issues. Through RFIs, CMS tries to take the pulse of providers’ positions on certain questions that could impact the Medicare Hospice Benefit.

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Hospice News

JULY 21, 2023

Centers for Medicare & Medicaid Services (CMS) contracts with RACs to conduct post-payment reviews designed to recover any funds that may have been overspent. Medicare hospice expenditures rise by about $1 billion annually, according to CMS. Many hospice providers express uncertainty about their ability to weather an audit.

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Hospice News

NOVEMBER 2, 2023

Centers for Medicare & Medicaid Services (CMS) finalized its home health rule for 2024 containing a new policy that will require anyone who holds 5% ownership or more in a hospice to submit a criminal background check, including fingerprints. On Wednesday, the U.S. They’re also providing clarification around what a ‘managing employee’ is.

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Hospice News

FEBRUARY 26, 2024

This includes tasks like clinical documentation, a major pain point for clinicians who wish to focus more on their patients. Partnerships and affiliations can help hospices mitigate the payment reductions that will likely occur within Medicare Advantage, as health plans generally seek to negotiate for lower rates.

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Hospice News

APRIL 6, 2023

Kevin Sarkisyan, of San Gabriel Hospice & Palliative Care, pleaded guilty to one count of conspiracy to defraud the government for his involvement in submitting false enrollment applications to Medicare that hid the “real owners of a hospice company,” according to court documents. Ghadimi is accused of misusing Medicare payments.

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Hospice News

SEPTEMBER 1, 2023

Four former employees of Care Alternatives have alleged that the New Jersey-based company billed Medicare for hospice services when patients were not eligible to receive them. Care Alternatives’ violations were not just isolated incidents, but were part of a pattern of significant noncompliance,” according to court documents.

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Hospice News

AUGUST 24, 2023

Centers for Medicare & Medicaid Services (CMS) has honed in on hospice program integrity, rolling out a swath of new measures to reduce fraud, waste and abuse in the space. A report from OIG found that roughly one-third of Medicare claims for hospice GIP services are billed in error, the OIG indicated.

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Hospice Nurse Hero

JANUARY 26, 2022

Hospice documentation is tedious and time-consuming. I’ve outlined simple tips to help you master the fundamentals of hospice documentation. Do you spend hours documenting at home? Worse yet, do you find yourself frustrated when “corporate” only seems to care about timely documentation? Documentation is king!!

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Hospice News

SEPTEMBER 8, 2023

Centers for Medicare & Medicaid Services (CMS) honed in on hospice program integrity through a number of new regulations, including some in the agency’s 2024 hospice final rule. The regulations focused on Medicare enrollment in an effort to stifle unethical or illegal activity in the space.

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Hospice News

JUNE 17, 2022

Aside from strong documentation, insight from hospice physicians around patient conditions is a key defense in appealing audits, experts say. Careful attention to documentation is essential to avoiding potential audits by the U.S. Centers for Medicare & Medicaid Services (CMS) or other agencies. It’s not black and white.

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Hospice News

SEPTEMBER 21, 2023

Court of Appeals indicated that incomplete or inaccurate medical records, including documentation errors, may establish materiality in an FCA litigation. Materiality” generally means a misstatement or misrepresentation could have influenced Medicare’s decision to pay or deny the claim.

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Hospice News

OCTOBER 28, 2022

Centers for Medicare & Medicaid Services (CMS) and the U.S. Modeling this documentation after CMS’ guidelines may be a key to avoiding scrutiny, he said. In recent years, the agency collected Medicare claims and associated documentation, finding issues related to beneficiary eligibility. In recent years, the U.S.

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Hospice News

JULY 5, 2023

A new cancer-focused payment model demonstration from the Center for Medicare & Medicaid Innovation (CMMI) could create opportunities for palliative care providers. Centers for Medicare & Medicaid Services (CMS). That’s another CMMI program that has an obvious palliative care tie-in.”

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Hospice News

FEBRUARY 23, 2023

Hospices are seeking greater clarity on updated Medicare rules that allow hospices to document a broader range of chaplain services on claims. A key factor in the CMS decision was the addition of chaplain services as a supplemental benefit within Medicare Advantage, which demonstrated a need to expand coding beyond the VA.

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Hospice News

JUNE 22, 2022

As hospices explore greater participation in alternative payment models, the Medicare Payment Advisory Commission (MedPAC) is urging Congress to reduce and restructure those programs. Hospice providers have been eying APMs emerging for the Center for Medicare & Medicaid Innovation (CMMI). While the U.S.

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Hospice News

JANUARY 3, 2023

The Hospice and Palliative Care Association of New York State tweeted a photograph of the veto document. New York’s hospice utilization rate was the lowest in the nation in 2020 at 24% among Medicare decedents, the National Hospice & Palliative Care Organization (NHPCO) reported. Centers for Medicare & Medicaid Services (CMS).

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Hospice News

NOVEMBER 27, 2022

A leading cause of fraud involves hospices billing Medicare for services for which patients were not eligible, according to a 2021 report from Bass, Berry, & Sims. Some hospices have already begun seeing penalties from a rise in UPIC audit activity, including reimbursement suspensions or Medicare claim repayments.

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Hospice News

JUNE 9, 2022

Centers for Medicare & Medicaid Services (CMS) contracts UPIC entities to conduct investigations and audits related to potential fraud, waste or abuse. Unified Program Integrity Contractor (UPIC) audits are on the rise among hospices, with some seeing penalties like reimbursement suspension or repayments.

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Hospice News

AUGUST 7, 2023

Centers for Medicare & Medicaid Services (CMS) has ramped up auditing activity tied to longer stays and more expensive levels of care such as GIP. Hospices have encountered a variety of audit types as CMS contractors conduct post-payment reviews designed to recoup Medicare funds that may have been overspent. Meanwhile, the U.S.

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Hospice News

MAY 22, 2023

Most Americans know how they want their end-of-life care to be handled, but roughly 1 in 3 actually document those plans, a recent study indicates. Sobol, chief medical officer for Medicare at Cigna, said a study of the company offerings pointed out a gap in coverage. “One Expansion is in Cigna’s immediate future, as well.

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Hospice News

AUGUST 8, 2023

Centers for Medicare & Medicaid Services (CMS) has put forth to strengthen hospice program integrity mirror rules implemented in years past for home health providers, including medical review processes and rules for when a provider can sell their business. CMS is no doubt hoping for similar results for the Medicare Hospice Benefit.

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Hospice News

MARCH 22, 2024

Centers for Medicare & Medicaid (CMS). Crucial to compliance is a hospice’s ability to assess its care delivery approaches, billing and patient intake processes, as well as clinical documentation, Dresang said. “We Also starting this year is a Special Focus Program for hospice providers from the U.S. It’s not a static issue.

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Hospice News

JANUARY 4, 2024

Centers for Medicare & Medicaid Services (CMS). A common refrain in discussions of health care quality and compliance, the issue often lies with incomplete or inaccurate documentation, according to Susan Mills, a registered nurse and senior program director for the Home Health, Hospice and Home Infusion Accreditation Programs at ACHC.

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Hospice News

JANUARY 30, 2023

Many hospice providers rely on Medicare Advantage (MA) reimbursement to support palliative care, PACE and social determinants programs, among others. Centers for Medicare & Medicaid Services (CMS) laid out its policy for validating MA plans’ risk adjustment data, which the agency uses to calculate capitation rates.

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