BKD and MAC Legacy collaborate to better serve home care, hospice industry clients MAC Legacy is honored to announce BKD as a collaborative partner. This new collaboration leverages BKD’s expertise in home care and hospice revenue cycle management services with MAC Legacy’s knowledge and proficiency in coding to better serve clients of both companies. “The…

On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update (CMS-1835-P), detailing planned changes to Medicare hospice payment rates, regulatory guidance, and updates to the Hospice Quality Reporting Program (HQRP).  These proposed changes are part of…

Our audit reviews continue to reveal the same key issues: eligibility, certification, and documentation. Medicare home health coverage isn’t just about providing care—it’s about clearly demonstrating the medical necessity through accurate and timely records. Home Health Eligibility: All Criteria Must Be MetTo qualify for Medicare home health services, the patient must: Plan of Care (POC)…

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…

The CDC’s National Center for Health Statistics announced that it will not hold a Spring Coordination and Maintenance (C&M) Committee Meeting for 2025. This meeting is normally held twice a year in the spring and the fall to discuss ICD-10 coding proposals.  The CDC website, states, however that this change will not affect the ICD-10-CM…

Hospices will begin completing the Hospice Outcome & Patient Evaluation (HOPE) on October 1, 2025.  The final HOPE item sets and HOPE guidance manual were released on September 16, 2024.  The HOPE data collection tool replaces the Hospice Item Set (HIS) but includes many of the same items.  Medicare-certified hospices will complete HOPE records for…

As of January 1, 2025, updated versions of the Notice of Medicare Non-Coverage (NOMNC, CMS-10123) and Detailed Explanation of Non-Coverage (DENC, CMS-10124) are in effect.  These changes, approved by the Office of Management and Budget (OMB), bring new requirements and enhanced clarity for providers and beneficiaries.  Medicare Advantage (MA) plans have an extended deadline for…

CMS has lifted the long-standing suspension of OASIS requirements for collection of data on non-Medicare/non-Medicaid patients. This means that Medicare-certified home health agencies will be required to collect and submit OASIS data on all patients, regardless of payer. The new guidance is included  in the OASIS-E1 guidance manual and CMS has also released a Q&A…

During its December meeting, the Medicare Payment Advisory Commission (MedPAC) issued draft recommendations advising Congress to reduce Medicare payments to home health agencies by 7% starting in 2026. The recommendations are part of MedPAC’s annual evaluation of payment adequacy across provider settings, which includes assessments of beneficiaries’ access to care, quality, capital availability, and cost-payment…

The Centers for Medicare and Medicaid Services (CMS) on November 13, 2024, posted the memo Ref: QSO-25-06-Hospice (Subject: Ensuring Consistency in the Hospice Survey Process to Identify Quality of Care Concerns and Potential Fraud Referrals) which outlines updated guidance to ensure consistency in the hospice survey process.  It emphasizes identifying and addressing quality of care…

On November 4th, CMS posted an updated Grouper Tool in order to capture the changes that will be effective on January 1st, 2025, regarding low and high comorbidity adjustments.  For fiscal year 2025, there are 22 Low comorbidity adjustments (same number as 2024) and 97 High comorbidity adjustments (down from the 102 in 2024).  Low…