The Office of Inspector General (OIG) creates a strategic work plan influenced by regulatory issues, Congressional concerns, and more, targeting various healthcare bodies across the United States. From time to time, this plan includes sections specifically for home health and hospice care. Today, we will discuss the most recent amendment made in June 2023, focusing on Hospice.
The new entry in the OIG work plan involves scrutinizing high-risk Medicare hospice admissions to General Inpatient Care (GIP). This GIP review will primarily concentrate on patients who were promptly transferred to GIP after an acute care hospital stay and certain diagnosis-related issues.
The issue at hand is the immediate transfer or election of hospice benefit by patients following an acute care hospitalization, potentially while still in the hospital. Although General Inpatient Care must take place in an inpatient facility, these patients may not necessarily need GIP-level care. We, at Healthcare Provider Solutions, have received concerns from hospices about this practice. Similarly, the National Association has reported receiving queries on the same matter. It seems that acute care hospitals are attempting to prompt hospices to admit patients under the Hospice benefit to avoid recording deaths within their own facilities.
Even when a Hospice is ready or capable of admitting a patient under the Hospice benefit, the fact that they are still in the hospital doesn’t automatically necessitate or qualify them for General Inpatient Care. To be eligible for GIP level of care, a patient must exhibit pain or other symptoms that cannot be managed in any other environment.
It’s essential to be thorough with patients under the GIP level of care, making certain they meet the necessary qualifications, and all documentation accurately reflects their eligibility for this benefit. If they don’t meet the criteria, they should be billed under the routine level of hospice care.
It is imperative that every level of care delivered by Hospice, whether it’s Routine, GIP, Inpatient Respite, or Continuous Home Care, is accurately documented. It is crucial to ensure that your patient meets the criteria for their specific level of care and that all documentation throughout their care journey supports them being invoiced under the correct level.
Should you need additional information about the General Inpatient level of care, please don’t hesitate to reach out to Healthcare Provider Solutions.
Subscribe now to have our weekly Monday Minute with Melinda sent directly to your inbox. Click here to subscribe!