Category Archives: Hospice Law

Subscribe to Hospice Law RSS Feed

Humana, TPG Capital, and Welsh, Carson, Anderson & Stowe Create the Country’s Largest Hospice Provider, “Kindred at Home”

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 … Continue Reading

Can AI Help Solve The Hospice Eligibility Question?

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 … Continue Reading

CMS Rolls Out Provider Appeals Settlement Efforts

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 … Continue Reading

Tax-Exempt Healthcare Organizations Brace for Impact as Senate Tax Reform Bill Passes

Update. We described in a previous blog post major changes that tax-exempt hospitals and other tax-exempt organizations in the healthcare industry face in the tax reform proposals working their way through Congress. In the early hours of Saturday, December 2, 2017, the Senate narrowly passed its tax reform bill. Although the Senate’s bill has much in common … Continue Reading

Tax-Exempt Hospitals & Other Tax-Exempt Healthcare Organizations Not Immune from Federal Tax Reform

As federal tax reform efforts proceed rapidly in both chambers of Congress, tax-exempt hospitals and other tax-exempt healthcare organizations are facing major potential changes. New tax burdens on tax-exempt organizations are among the ways in which the bills would raise revenue to pay for proposed tax cuts for businesses and individuals. Importantly, it is still … Continue Reading

Hospice Live Discharges: Some Perspective

News outlets have noted that hospices discharge, on average, 1 in 5 patients alive. The presumptive and easy explanation, one that fits political assumptions, is profit motive: for profit hospices admit unwitting patients, earn fees, then discharge them alive. The truth is that assessing when someone will pass away is among the most complex medical determinations. … Continue Reading

CMS Plans To Reopen Cap Demands Forever

In recent weeks, hospice providers have been receiving revised cap demands for fiscal years 2012 and earlier.  Although the initial demands in these cases were issued more than three years earlier, CMS now claims that it can reopen and revise cap demands for up to three years from the most recent demand.  Based upon this … Continue Reading

Hospice Cap Calculation Changes

Traditionally, the cap accounting year has ended October 31, putting the cap accounting year one month off of the Federal government fiscal year.   In May 2015, CMS proposed to adjust the cap accounting year to end September 30 to align with the Federal government fiscal year.  This transition will occur in 2017. To change the accounting … Continue Reading

CMS Issues Suggested Notice Of Election Statement

Following an OIG report on election statements in September, CMS has posted a suggested, but not mandatory, notice of election statement. From inception of the benefit, hospices have been required to formulate their own notice of election.  Regulations require only that the election statement: (a) identify the hospice; (b) identify the attending physician chosen by the … Continue Reading

ZPICs Terrorize, Close Hospices; CMS Blesses Approach

In recent months, ZPICs, tiring of the post-payment audit due process constraints imposed by Congress, have begun utilizing devastating and unlawful tools to put hospices, and presumably other providers, out of business – full payment suspension and full prepayment audit.  CMS has now reviewed and blessed this conduct. In the case of a longstanding Puerto … Continue Reading

OIG Issues Report On Hospice Election Statements

On September 16, 2016, the Office of Investigator General for CMS issued a report on hospice election statements, concluding that many of the statements in use by hospices are deficient in some respect.  In its review of 565 election statements, OIG concluded that 35 percent were deficient in some manner. Hospice patients are required to … Continue Reading

CMS Proposes ALJ Hearing Changes

As most hospice providers know all too well, CMS faces an ever growing backlog of ALJ cases.  This backlog stems in large part from aggressive audit procedures employed by ZPICs, RACs, and MACs that issue sweeping numbers of pre- and post-payment denials, often on less than substantive or meritorious grounds, leading to more appeals.… Continue Reading

Hospice Payment Changes Take Effect

With the advent of the 2016 (Happy New Year!), hospices now face the revised hospice payment system. Specifically, Medicare will pay a higher routine home care rate for the first 60 days of care ($187 average) and a lower routine home care rate for days beyond 60 ($147 average).  These adjustments are supposed to be … Continue Reading

Hospice False Claims Case Helps Clarify Law

Following a trial in which a national hospice chain (AseraCare) was initially found to have submitted false claims, the Court ordered a new trial.  In making this rare order, the Court acknowledged that it had failed to provide the jury with proper instructions as to required findings for a false claim, including that the government … Continue Reading

Hospice Cap Sequestration Update

In March 2015, CMS instructed its contractors to add sequestered funds, amounts never paid to providers, to revenue for purposes of calculating the hospice cap. This results in cap repayment demands that are overstated, in that they require repayment of funds never received.… Continue Reading

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 … 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 … 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 … Continue Reading
LexBlog

By scrolling this page, clicking a link or continuing to browse our website, you consent to our use of cookies as described in our Cookie and Advertising Policy. If you do not wish to accept cookies from our website, or would like to stop cookies being stored on your device in the future, you can find out more and adjust your preferences here.

Agree