Category: Hospice Reimbursement

Targeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons

By Melinda Gaboury / Posted on: May 30, 2019

As long as hospices are carefully documenting the details of each patient’s clinical situation and each patient meets the eligibility requirements for hospice care—these denials are avoidable. Don’t be the hospice that gets technical denials for careless mistakes, like incorrect format of the election statement or completing CTIs with boxed/canned statements that are not specific to the patient.

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8 Major Changes Outlined in the FY2020 Hospice Wage Index Update

By Leslie Heagy / Posted on: May 3, 2019

The FY2020 Hospice Wage Index & Payment Rate Update & HQRP Proposed Rule presents significant changes to rates and election statements. This proposed rule needs our full attention and comments! Please do your part and comment by the deadline stated in this article.

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Documenting Hospice Eligibility for Alzheimer’s Dementia

By Leslie Heagy / Posted on: March 22, 2019

When admitting a patient to hospice with a primary terminal diagnosis of Alzheimer’s disease, your documentation should clearly show the nature and condition causing the hospice admission in addition to, the hospice disease-specific LCD guidelines.

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Required Hospice GIP Documentation

By Leslie Heagy / Posted on: February 4, 2019

General Inpatient (GIP) Care is one of the four levels of care available to patients who elect the Medicare Hospice Benefit. When may GIP level of care be appropriate? When is it NOT appropriate to use GIP level of care?

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Hospice Item Added to OIG Work Plan – Protecting Medicare Hospice Beneficiaries from Harm

By Leslie Heagy / Posted on: January 2, 2019

The OIG released a hospice portfolio report Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity in July of 2018, identifying vulnerabilities in the Medicare Hospice Program and made 16 recommendations to CMS to strengthen the hospice program.

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Top Denial Reasons – Hospice Targeted Probe and Educate

By Leslie Heagy / Posted on: September 11, 2018

Targeted Probe and Educate (TPE) is underway for Hospice Agencies. HPS is seeing many ADR denials with agencies moving to round 2 and 3 of TPE from both CGS and NGS.

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Hospice HEART Update

By Katie Wehri / Posted on: July 30, 2018

The retooling of the Hospice Evaluation and Assessment Reporting Tool (HEART) is a significant development. CMS has been moving rather expeditiously on the HEART tool, and it is believed the tool is one of the key components necessary for future changes in hospice including payment refinement.

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Big Changes for Hospice Billing – MLN Matters SE18007

By Katie Wehri / Posted on: July 11, 2018

CMS recently released MLN Matters SE18007 which details recent and upcoming improvements to Medicare hospice billing. Two recent improvements – Electronic Submission of the Notice of Election (NOE) and Correcting Election or Revocation Dates using Occurrence Code 56 – are summarized and additional upcoming improvements are addressed.

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Hospice Utilization & Payment Public Use File

By Katie Wehri / Posted on: June 13, 2018

CMS is proposing to add Hospice Utilization and Payment Public Use File (Hospice PUF) data to Hospice Compare. The PUF data is derived primarily from hospice claims and the most current PUF data is from FY2015. The data would be in a segregated section of Compare as it contains information about hospice payments and utilization not quality measures.

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Hospice FY2019 Proposed Rule – Payment and Quality Reporting Program

By Katie Wehri / Posted on: May 4, 2018

The FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements proposed rule was recently made available. Of concern is the fact that CMS found 66% of hospice cost reports would have been rejected had certain edits been in place. Check back soon for future blog articles containing more detailed information about the quality reporting program updates and comments in the proposed rule.

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Hospice Quality Measure Reports Available

By Katie Wehri / Posted on: April 23, 2018

The Centers for Medicare and Medicaid Services (CMS) recently announced that corrections have been made to the hospice quality measure reports available in CASPER and are now ready for viewing. It has come to our attention that some hospices are not aware of these reports and are not accessing them and are missing out on valuable information. To get started with CASPER…

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Hospice MedPAC Report to Congress

By Katie Wehri / Posted on: April 4, 2018

Each year the Medicare Payment Advisory Commission (MedPAC) submits its annual report to Congress which contains information and recommendations related to Medicare fee-for-service (FFS) programs. This article details the 2018 annual report recommendations for Hospice.

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Targeted Probe and Educate – What We Have Learned So Far

By Melinda Gaboury / Posted on: March 13, 2018

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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Home Health & Hospice PEPPER Reports

By Melinda Gaboury / Posted on: January 15, 2018

Over the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…

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New Medicare Beneficiary Identifiers

By Melinda Gaboury / Posted on: December 20, 2017

HPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…

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Preparing for Hospice Targeted Probe and Educate (TPE)

By Katie Wehri / Posted on: October 31, 2017

As previously reported, the targeted probe and educate (TPE) process is replacing the medical review process used by Medicare Administrative Contractors (MAC).  Each of the three MACs – Palmetto GBA, NGS and CGS – can choose the topics for review under TPE based on existing data analysis procedures.

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Hospice CTI and Election Statement Made Easy

By Katie Wehri / Posted on: October 16, 2017

CMS reminded hospices recently about the need to comply with Medicare hospice election statements and certification of terminal illness (CTI) requirements. This reminder comes shortly after CMS’ announcement of the expansion of the targeted probe and educate (TPE) method of medical review to hospices and other provider types. We believe there is a strong possibility that CMS will…

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New Medicare Cards – Questions Answered

By Melinda Gaboury / Posted on: October 10, 2017

HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…

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Corrections to SIA & RHC Made Easy

By Katie Wehri / Posted on: September 29, 2017

CMS announced this week that Medicare Administrative Contractors (MAC) will accept a list of claims to be adjusted for incorrect service intensity add-on (SIA) and incorrect routine home care (RHC) payments, where the error is not related to hospice beneficiary transfers. The SIA and high/low RHC payment changes were…

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Targeted Probe and Educate

By Melinda Gaboury / Posted on: September 25, 2017

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.

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Hospice General Inpatient Care

By Katie Wehri / Posted on: September 18, 2017

CMS is concerned about hospice over utilization and hospice underutilization of the general inpatient (GIP) level of care. CMS wonders if hospices are providing access to all four levels of hospice care (routine home care, general inpatient care, respite care and continuous home care) when it sees that some hospices have billed very little or no GIP care during a specified time period. On the other hand, CMS wonders if the…

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2018 Hospice Final Rule & NOE Electronic Submission

By Katie Wehri / Posted on: August 4, 2017

Late Tuesday, August 1, 2017 the final hospice rule – FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements – was posted. The rule contains the FY2018 finalized payment rates, aggregate cap, and hospice quality reporting changes. On July 27, 2017 CMS released Transmittal 3813/Change Request (CR) 10064 – Accepting Hospice Notices of Election via Electronic Data Interchange. Hospices will be happy to hear…

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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier

By Aaron Carey / Posted on: June 22, 2017

Former President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…

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Hospice Proposed Rule

By Katie Wehri / Posted on: April 27, 2017

Late Thursday, April 27 the proposed hospice rule – FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements – was posted. The rule contains the proposed FY2018 payment rates, aggregate cap, and hospice quality reporting changes. The proposal is also an opportunity for CMS to provide comments on various other issues and solicit feedback. The proposed rule is open for inspection and CMS is accepting comments from hospices, stakeholders, and the public until June 26. CMS will review the comments and the final rule is anticipated to be released at the end of July. This detailed post will be continually updated with the latest information from CMS regarding the 2018 proposed hospice rule…

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How To Access The Provider Statistical & Reimbursement Report

By Aaron Carey / Posted on: March 17, 2017

It is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.

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HIPAA for Home Care | Establishing A Compliant Agency

By Drew Rowley / Posted on: March 3, 2017

HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?

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Hospice Regulatory Update

By Melinda Gaboury / Posted on: August 18, 2016

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Key Points Regarding 2016 Hospice Payment Reform

By Melinda Gaboury / Posted on: February 19, 2016

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Hospice CAHPS Surveys Will Affect Payment

By Melinda Gaboury / Posted on: January 29, 2016

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2016 HHRG Tables & Hospice CBSAs!

By Melinda Gaboury / Posted on: December 22, 2015

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2016 HHRG Tables & Hospice CBSAs!

By Melinda Gaboury / Posted on: December 22, 2015

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Ushering In 2016 – Kick off the Year Right!

By Melinda Gaboury / Posted on: December 11, 2015

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New G-Codes Not JUST for HOSPICE!

By Melinda Gaboury / Posted on: October 23, 2015

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The Complexities of Medicare Secondary Payer Billing

By Aaron Carey / Posted on: October 16, 2015

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The Y2K of Coding!

By Melinda Gaboury / Posted on: October 5, 2015

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Finally Some Relief or Not!

By Melinda Gaboury / Posted on: September 29, 2015

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Home Care and Hospice: Still No Relief!

By Melinda Gaboury / Posted on: September 11, 2015

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CMS Issues 2016 FINAL Hospice Payment and Quality Rule

By Melinda Gaboury / Posted on: August 7, 2015

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Medicare Web Portals – Navigating the “Dark Days”

By Aaron Carey / Posted on: June 28, 2015

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Hospice Medicaid Room and Board Billing Tips

By Aaron Carey / Posted on: June 7, 2015

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CMS Issues FY2016 Proposed Hospice Payment and Quality Rule

By Melinda Gaboury / Posted on: May 6, 2015

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Hospice Untimely NOE and CAP Self Reporting

By Melinda Gaboury / Posted on: March 3, 2015

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