Hospice Benefit Eligibility

Just last month, the Office of Inspector General (OIG) announced its intent to perform a nationwide review of hospice beneficiary eligibility.  This action was in response to identified recent negative findings during individual provider audits by the Office of Audit Services.  In their audits, they found a pattern of patients who did not meet eligibility requirements for the Medicare hospice benefit.  In response to this issue, the OIG has decided to initiate a nationwide audit of hospice beneficiaries who, prior to election of the hospice benefit, did not have an inpatient hospital stay or an emergency room visit in certain periods.  This audit is expected to begin in 2023.  Hospice organizations need to be proactive in preparation for this review.  An action plan includes a determination of all current patients who meet this OIG audit criteria regarding previous hospitalization or ER visit.  Once this is established, a focused audit of these clinical records should be performed to ensure all eligibility requirements are met and properly documented.  Hospices would be wise to re-educate all staff on eligibility requirements.  If problem areas are found during the self-audit, initiate a Performance Improvement Project as part of your QAPI program.  Need help?  We’re here to assist you!