ALJ Now Dismissing Hospice Appeals For Allegedly Insufficient Service On Beneficiary

In the last few years, we have seen a growing and alarming trend of administrative law judges (“ALJ”) dismissing appeals solely based on purported lack of service to the hospice patient (the Medicare beneficiary).  A search of recent decisions shows over 150 such cases at the Medicare Appeals Council starting in 2012 and continuing to the present.  Administrative law judges appear to increasingly be using these grounds as a basis for dismissal. Continue Reading

Sequestration Adjustments To Hospice Cap – See Examples

As quietly promised, Medicare Administrative Contractors (NGS, Palmetto) have begun issuing FY 2013 cap demands with sequestration (money never paid) included as a part of revenue, thus overstating the demands.  The demand letters themselves do not call out the sequestration adjustment.  To see the increase in revenue, and thus increase in demand, hospices need to review the cap calculation table. Continue Reading

Hospices To Self-Report Cap Without Sequestration; MACs To Capture Sequestration Later

This week, the Medicare Administrative Contractors issued instructions for hospices to self-report FY 2014 hospice cap (reports due this month, March 31, 2015).  These instructions include a spreadsheet substantially similar to what we offered earlier this year.  Hospices that fail to submit reports by March 31 may be subject to payment suspension until reports are completed.  Continue Reading

Attending Physician Documentation Changes Increase Audit Risk

On October 1, 2014, CMS revised its attending physician requirements, setting another potential trap for the unwary.  42 C.F.R. 418.24 [Election of Hospice].

While statute and regulation have long required both the attending physician and hospice medical director to certify initial eligibility, CMS has now tightened regulation around identification and change of attending physician.  The natural result of this change will be a more stressful hospice election process for new patients and increased audit risk for hospices.

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CMS Plans To Add Sequestration Dollars To Hospice Cap

This week at an Open Door Forum, CMS finally disclosed a long-rumored plan to overstate hospice cap liability for hospices, and thereby grab more overpayments, by adding sequestered revenue to hospice revenue.  For hospices, if not challenged, this will mean that revenue will be artificially inflated by approximately 1% for 2013 (and 2% for 2014 and future years) by money never paid to the hospice (i.e., money withheld through sequestration).

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2014 Cap Year Mandatory Hospice Cap Calculation – Be Ready

With the 2014 cap year just concluded, it’s time to think about the new cap calculation requirements.

Over the summer, CMS finalized its revisions to the hospice cap rule, requiring hospices beginning with cap year 2014 (just completed) to calculate and return hospice cap overpayments within a very tight window.  Hospices that fail to submit this calculation and, if applicable, repayment (or repayment plan) will be subject to suspension of all reimbursement pending completion of the report/repayment.

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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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