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…
Tag: hospice
Claim Denial
Nothing can be quite as deflating to hospice leadership and staff as these words. Whether hospices are in the midst of TPE or other medical review, a common denial reason is failure to support the six-month terminal prognosis. Diagnosis alone may not suffice in establishing the physician’s prediction of the patient’s life expectancy. Hospices with…
Hospice Certification
As scrutiny of hospice organizations increase, it’s particularly important for hospices to ensure their certifications and recertifications of terminal illness meet all required elements. In the 2021 Medicare FFS Supplemental Improper Payment Data report of improper payments, the top cause for error was “insufficient documentation of the physician’s certification/recertification”. A few short months from now,…
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…
Hospice Election Statement Addendum
October 1st marked the beginning of the hospice fiscal year and implementation date of some changes detailed in CMS’ Hospice Final Rule. One particular modification has to do with the Hospice Election Statement Addendum. Hospices are now required to include a “date furnished” on the addendum and this date must also be recorded in the…
Hospice Final Rule
The hospice final rule for Fiscal Year (FY) 2022 was issued on July 29th. This 226 page document–CMS-1745-F–addresses a number of changes including the hospice wage index, payment rates, and aggregate cap amount for FY 2022. Specifically, hospices who submit quality data will receive a 2% raise in payment rates. Hospices who do not submit…
Hospice Expansion
As the elderly population increases along with chronic and age-related diseases, the hospice industry is projected to expand over the next few years. In surveys performed by AARP and others, it’s not surprising to find that most adults have a preference to age in place as long as possible. Earlier this year, MedPAC reported a…
Hospice Survey Reform
The HOSPICE Act passed out of the House on December 8, 2020. In the version of the bill that will pass as part of the Consolidated Appropriations Act, 2021, routine hospice survey frequency will remain permanently at 36 months (as opposed to 24 months as proposed by the House). The OIG made the following recommendations related…
Proposed Hospice Final Rule Change
CMS proposes to make some of the waiver changes permanent. One of these modifications is regarding hospice aide training. The current CoP, 418.76 (c)(1) specifies aides must be evaluated by observation of their performance of the task with a live patient. The proposed change would affect CoP 418.3 by allowing evaluation of aide competency to…
