Tag Archives: CMS

CMS Proposes To Shift Hospice Funding From Routine To Enhanced Care Days

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 … 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 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

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 … Continue Reading
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