Direct Data Entry (DDE) access is a company’s revenue lifeline: without it, hospices cannot comply with NOE filing requirements or submit claims for payment. Every hospice has DDE login rights, but many fail to recognize (and take due care to avoid) the serious hidden pitfalls that are found in this system. Failure to avoid these pitfalls can cause loss of access; and, in turn, hospices face at least significant administrative work to recover access and perhaps forfeiture of certain billings (if NOEs cannot be timely filed). Many hospices (and other Medicare providers) have found themselves in crisis mode based upon billing employee departures, forgotten passwords, and suspended/deactivated accounts. Continue Reading
Last week, the 11th Circuit Federal Court of Appeals reversed summary judgment given to AseraCare in its hospice false claims case, setting up more litigation on the question whether AseraCare’s certifications were made in good faith. But, the appeals court also affirmed a critical trial court ruling on the standard to be applied to review of hospice claims for “falsity,” holding that a mere difference of opinion among physicians is insufficient to establish that a claim is false; and, holding that, a “physician’s clinical judgment dictates eligibility as long as it represents a reasonable interpretation of the relevant medical records.” Continue Reading
On August 6, 2019, CMS finalized its 2020 hospice rule, including adopting, without substantial modification, two controversial and material changes to the hospice benefit:
- Rebasing payment rates to shift about $500 million from routine care to enhanced levels of care including general inpatient, continuous, and respite care.
- Adopting a requirement that, upon request (either at admission or later), hospices disclose in an extensive written addendum to patients (and other health care providers) any care that would be deemed unrelated to hospice care.
We reviewed these proposals in detail in prior blogs posts on rebasing and unrelated care disclosures; and, we submitted these comments to CMS. In this blog, we will note the changes that CMS did make to these proposals and note some of the potential effects. Continue Reading
With the FY 2020 proposed hospice rule, CMS proposes two material changes for hospice providers:
- CMS proposes to shift approximately $500 million of hospice funding (2.7% of payments) from routine care to enhanced care payments (inpatient, continuous, and respite care); and
- CMS also proposes, as a condition of payment, to require hospices to provide patients with a complete list (on request) of any services, drugs, or treatments that will be deemed unrelated to terminal illness (and therefore covered separately by Medicare).
In its FY 2020 proposed hospice update, CMS proposes two changes of significant interest to providers:
- Shifting $500 million of reimbursement from routine to enhanced care levels; and
- Requiring providers to notify patients in writing of treatments that will be deemed “unrelated” to the terminal illness (and therefore still covered by Medicare separately).
Given that both of these topics deserve significant attention, we will address them in separate posts. This first post covers the notice of unrelated treatments. Continue Reading
On Thursday, February 28, 2019, two years after hearing arguments in lead group cases, the Provider Reimbursement Review Board affirmed CMS’ approach to counting sequestered funds as part of provider revenue for hospice cap calculations.
In 2012, to address budget deficits, Congress passed the Budget Control Act, providing for, among other things, a 2% reduction in all payments to Medicare providers. Beginning in fiscal year 2013, acting under Executive Order, CMS began reducing payments to Medicare providers by 2% across the board.
Hospices were no exception. A hospice entitled to payment of $100 has since 2013 received just $98; $2 of each $100 have been withheld and never paid. Continue Reading
Though beloved as a service, hospice can be a difficult subject for patients, families, and even caregivers. The recent short film, End Game (2018 NetFlix), follows a set of patients, families, and their caregivers through the difficult discussions and choices faced at end of life. It may help facilitate difficult discussions.
End Game provides a glimpse of hospice services at San Francisco-based UCSF Hospital and its affiliated Zen Hospice Project, an end-of-life urban end-of-life residence home. The film follows four patients and their families through different stages of end-of-life decision making, directly addressing the grief, conflict, and uncertainty surrounding death. Continue Reading
This article was originally posted on the Healthcare Law Blog on July 12, 2018.
Kindred Healthcare. On July 2, 2018, Humana Inc. and private equity firms TPG Capital (TPG), and Welsh, Carson, Anderson & Stowe (Welsh) (collectively referred to as the Consortium) issued a press release announcing the closure of their $4.1 billion joint acquisition of Kindred Healthcare, Inc. Kindred Healthcare, Inc. is a national owner/operator of long-term acute care hospitals, inpatient rehabilitation facilities, rehabilitation service providers and, through Kindred at Home (KAH), home health agencies, hospices, telehealth providers, and community care facilities. Continue Reading
Medicare beneficiaries are eligible for hospices if they have a life expectancy of six months or less if the illness runs its normal course. And, while providers can take an objective set of characteristics (FAST score, PPS, hospitalizations, MAC, etc.) and predict life expectancy for a population around an average, no one has come close to perfecting the practice. Continue Reading
This year CMS is rolling out two new programs aimed, finally, at helping to settle certain types of pending provider reimbursement appeals. The programs are the Low Volume Appeals Initiative and Settlement Conference Facilitation.
As pointed out in this space before, CMS’ longstanding policy of refusing to negotiate overpayment findings has been a significant factor in clogging the appeals system. With no settlement options, each case must be decided on its merits, imposing a huge (indeed unmanageable) burden on the appeals system. Continue Reading