New CMS Hospice Item Set Reporting Invades Privacy Rights

For admissions on and after July 1, 2014, CMS will require hospices to file detailed reports (link) for every patient served including every type of personal information (social security number, full name, Medicare HICN, DNR detail, and details about the terminal illness and treatment).  While there are many aspects of this reporting requirement that have drawn criticism, one requirement constitutes a significant and unjustified invasion of privacy: Reporting requirements extend to every patient, without regard to whether they are Medicare beneficiaries.

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Notes from AHLA Presentation on Post Payment Audits

On February 20, 2014, Brian Daucher and Claudia Reingruber (Reingruber & Assoicates) presented “Medicare Post Payment Audits (RACs, ZPICs, and Other Tools)” to the American Health Lawyers Association Annual Meeting for Long Term Care and the Law Conference (presentation) in Las Vegas, Nevada.  The presentation covers the structure and operational characteristics of Zone Program Integrity Contractors, tools to prepare for such audits, and advice about useful appeal arguments related to such audits.  Here are some key takeaways.

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Notes On Increasing Acute and Post-Acute Integration

The focus of the AHLA Long Term Care Conference was on convergence of acute (hospital) and post-acute (SNF, home health, hospice) service delivery mechanisms.

A number of forces promote this convergence including:

  • Accountable care organizations forming integrated delivery systems including doctors, hospitals, and post-acute services;
  • Growth of exchange based insurance alliances that limit post-acute choices for the pre-Medicare population;
  • Growing Medicare Advantage plans with forthcoming integration of the hospice benefit for the Medicare population.

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MEDPac’s View of the Hospice Benefit: December Meeting Update

MEDPac recently published the transcript of its December 2013 meeting where a number of hospice issues were discussed, including: (a) payment update/adequacy (recommending – no payment update for 2015); and (b) potential integration of the hospice benefit into Medicare Advantage plans (recommending integration by 2017).  Here are some notes on the meeting.

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Hospice to Provide “Virtually All” Care – First Up, Prescription Drugs

A hospice patient waives the right to receive other Medicare benefits “related” to the terminal illness.  In turn, the hospice must provide any care necessary for “pain or symptom relief.”  Focusing upon this waiver/assumption of liability, CMS is now redefining the scope of a hospice’s duty, requiring hospices to pay for “virtually all” prescription drugs and other care given to hospice patients.

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‘Tis The Season for Hospice Probe Edits – Be Ready

Palmetto GBA has announced a new non-cancer prepayment edit targeted at hospices with significant nursing home populations.  Many providers have been through similar non-cancer probe edits repeatedly, while for others this may be a new experience.  In this post, Sheppard Mullin reviews several important points for providers facing such edits (from any Medicare Administrative Contractor).

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Hospice Face 2 Face Audit Update

Effective April 2011, CMS implemented the Affordable Care Act requirement that hospices conduct a face to face visit as part of any recertification of any beneficiary in the third or later benefit period.  With the forthcoming hospice and home health RAC auditor, hospices will face increasing audits on face to face compliance.  In this post, Sheppard Mullin examines some of the key requirements of the face to face requirement.

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A Review of CMS’ Approach to $125 Million Recoupment of Payments to Providers for Services to Incarcerated / Unlawfully Present Beneficiaries

CMS seeks to recover from providers $125 million in alleged overpayments for services to beneficiaries who are belatedly identified as ineligible (incarcerated/unlawfully present).  In this post, Sheppard Mullin examines the recovery process CMS has put in place, noting CMS procedural shortcomings and reviewing some substantive defenses available to providers facing such demands.

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