Health Care Groups Urge Lawmakers to Relax Prior Authorization Rules

A group of 370 health care industry groups — including the American Academy of Hospice & Palliative Medicine, the American Medical Association and National Association of Social Workers — have signed a letter sent to Congress encouraging legislators to pass the Improving Seniors’ Timely Access to Care Act of 2019. If enacted, the legislation would […]

MedPAC Mulls 20% Cut to Hospice Payment Cap

The Medicare Payment Advisory Commission (MedPAC) is considering a recommendation that Congress reduce by 20% the annual aggregate payment cap for hospice care. Also under consideration is a potential recommendation to adjust the cap according to the wage index for different geographic regions to reflect the varying costs of care in different parts of the […]

Trump Seeks to Align Fee-for-Service Payment with Medicare Advantage Rates

As hospices await implementation of a Medicare Advantage hospice carve-in demonstration, President Trump has signed an executive order that seeks to bring Medicare fee-for-service rates in line with Medicare Advantage payments, among other provisions. The executive order is part of an effort to counter Medicare-For-All policies put forth by Democratic presidential candidates, which were the […]

Hospice Legislation Comes Closer to House Vote

The number of cosponsors for the Palliative Care and Hospice Education and Training Act has reached the 290 the bill needs to come to a vote in the U.S. House of Representatives. A second bill, the Rural Access to Hospice Act, will likely be folded into a larger yet-to-be-determined piece of legislation. If enacted, PCHETA […]

CMS Rule: Hospitals to Inform Patients of Post-Acute Quality Data

The U.S. Centers for Medicare & Medicaid Services (CMS) has published a final rule on hospital discharge planning that underscores the need for hospices to leverage their publicly reported quality metrics as a competitive advantage. The new rule requires hospitals to inform patients about their choices related to post-acute care providers including those organizations’ performance […]

Modernizing the Medicare Hospice Benefit

The Medicare Hospice Benefit is aging along with the patients it is designed to serve. Nearly 40 years since its inception, it may be time to re-examine aspects of the program in light of the ways that patient populations and the larger health care system have changed.  The hospice benefit was established as a demonstration […]

On the Horizon: Value-Based Hospice Care

The U.S. Centers for Medicare & Medicaid Services (CMS) is experimenting with the concept of including hospice in value-based payment models, as evidenced by the forthcoming Medicare Advantage carve-in, the Medicare Care Choices model and the Primary Care First initiative. While the agency has no immediate plans to transform the Medicare Hospice Benefit’s per diem […]

Health Experts Propose Alternatives to Using Claims Data for Primary Care First Eligibility

As the U.S. Centers for Medicare & Medicare Services (CMS) prepares to launch the Primary Care First Seriously Ill Population payment model in 2020, the agency should consider mining data from the home health care population to identify eligible patients rather than claims data, a group of physicians argue in a recent editorial in Health […]

Court: Difference of Opinion is Not Hospice Fraud

The Eleventh Circuit Court of Appeals partially affirmed a decision in favor of Arkansas-based hospice provider AseraCare in False Claims Act (FCA) case that has widespread implications for the hospice industry. The appellate court agreed with the Northern District of Alabama that a mere difference of physician’s opinions on a terminal patient’s prognosis does not […]

Hospice to OIG: Medication Billing Not So Simple

Federal watchdogs recently called out the hospice industry on medication billing practices on the grounds that Medicare was paying twice for some drugs, but many hospices feel they lack clear direction as to what should be covered as they contend with the inherent complexity of diagnostic processes. Hospices nationwide billed Medicare Part D a combined […]