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).
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.
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.
In its May 2014 publication of the 2015 Hospice Wage Index update, CMS proposes that hospices be required to calculate, report and pay their own hospice cap liability, with reports to be due five months past fiscal year end (i.e., by March 30 of each year after fiscal year end October 31).
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.
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.
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.
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.
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).
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.