Hello everyone, and welcome to our Monday Minute. Today I want to share with you a release of data from the OIG that has some (people) very concerned regarding hospice.
We know that there have been all kinds of medical reviews now opened again, following it being put on hold at the beginning of the Public Health Emergency and as of September 1, 2021, they have opened all dates of service and all medical reviewers basically have free reign as they did before the Public Health Emergency. In the opening up of that medical review, we have seen an unreal amount of audits being conducted on Hospices. We just recently learned that the OIG had said they were going to be doing some additional audits on Hospice. And then this past week, they have released information that spells out some of the data that is driving this additional audit that they’re going to be doing. A few years ago, any of you that are involved in Hospice will remember the OIG audit that uncovered millions of dollars that were being paid out of the Medicare Part D fund for drugs while a patient was on Hospice. As a result of that, many changes came to what was required in Hospice, including some specific drugs that are very typical in Hospice were restricted for pharmacies to even fill those prescriptions, if a patient were in the system as a Hospice patient. There has since been other evidence that other drugs, other than the limited ones, are being paid for by Medicare Part D, even while the patient is on Hospice.
The release of data that just occurred this past week, includes the discovery of all of the money that Medicare Part A and B are paying to non-Hospice providers while a patient is on Hospice. This leaves the OIG very concerned. One of the reasons that CMS implemented the election statement addendum last October 2020, was specifically geared at allowing hospices to have a tool to be able to share with patients, the items, services, and drugs that they had determined to be unrelated to the terminal condition and related conditions. As a result, there may have been some differences in the items, services and drugs that Hospices now realize they must provide, but the data from the OIG is based on 2019, and actually is from 2010 through 2019. So basically a 9-to-10-year period, which shows billions of dollars being paid in non-Hospice services while patients are on hospice. The OIG data release alludes to the fact that they expect that this data will be instrumental in looking at payment reform for the Hospice benefit, and to put restrictions in place to prohibit non-Hospice services to be paid when they really should be included in the Hospice benefit. We have known that Part D was a problem for a very long time. I don’t know that we were really thinking about or aware that there were so many Part A and B services being paid to non-Hospice providers while patients were on hospice.
What do you do if you’re a Hospice provider, you begin to look at your internal processes immediately and determine that you are truly including and providing everything that you should be providing as a part of the per diem payments that you’re being paid as a Hospice provider for the care of your patients.
You also can look at data. For example, from the PEPPER Report, the PEPPER Reports added a target in the update that was released in April 2021. That includes a calculation to determine what percentage of your patients had Medicare Part D expenditures while your patients were on Hospice. That’s a good place to start if you don’t know where to start. The reality is, the Hospice benefit was made or built to be a pretty much all-inclusive benefit and it’s proven that this has not been the case. And this data basically is just giving more fuel to the stance that CMS is duplicating Medicare payments when they are paying Hospices per diem, and then paying additionally out of other funds for those services that really should have been included in those per diem payments.
We do expect, in addition to all the medical review that’s happening by the Medicare contractors now, that there are going to be more OIG audits coming in the very near future. My anticipation and this is solely my anticipation, is that they will likely be looking at those data reports that look at specific Hospices and percentage of money that’s being spent on those Hospice patients for non-Hospice services, and likely audit the ones that have the highest percentage of non-Hospice services being paid while their patients are on service.
I really, truly feel like we are a blessed industry in Home Health and Hospice. I truly am thankful for all of you out there on the front lines. When things like this come to light, it’s a very difficult situation, especially for all the providers out there that are trying so hard and so diligently to truly take care of patients and make their lives easier. I want to make sure that you’re aware of this report. Also, make sure that you again are tuned in to your State and National Home Care and Hospice associations to keep updated on the latest information regarding not just this audit, but anything that might be coming down the pike that affects your Hospice, or even Home Care.
Thank you all again, for taking care of patients for listening today. We will provide a link in this minute to the OIG data released. Thank you and have a fabulous week.