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 […]

Hospices Ready Themselves for the Medicare Advantage Carve-In

Though hospices remain in the dark about the inner workings of the forthcoming Medicare Advantage carve-in, some are using their knowledge and experience in working with payers to take the first steps toward implementation. The U.S. Centers for Medicare & Medicaid Services (CMS) earlier this year announced that it would test coverage of hospice care […]

Wisconsin Legislature Mulls Palliative Care Bill

A bi-partisan bill before the Wisconsin Legislature would set up a Palliative Care Council within the state’s Department of Health Services, as well as establish a public education program on palliative care. If the bill is enacted, Wisconsin will join a growing list of states in establishing laws to promote palliative care as legislators and […]

OIG: CMS Needs to Stop Paying for Some Hospice-Related Drugs Twice

The Centers for Medicare & Medicaid Services (CMS) needs to do more to make sure taxpayer dollars aren’t being wasted when it comes to paying for hospice patients’ drugs, a report released Tuesday by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found. As part of an ongoing audit […]

CMS Proceeding on New Hospice Quality Measure Development

The U.S. Centers for Medicare & Medicaid Services (CMS) is developing two new claims-based quality measures for hospices, to track avoidable transitions from hospice care as well as access to levels of hospice care. CMS does not require hospices to collect or submit data on claims-based measures. The agency itself assembles the data based on […]

MA Carve-In Could Forego 6-Month Prognosis Rule for Hospice

Medicare Advantage plans would not necessarily be bound by Medicare’s six-month terminal prognosis requirement under a forthcoming hospice carve-in. Medicare Advantage plans are offered by private insurance companies approved by CMS, and include HMO, PPO, and fee-for-service plans among other options. The program represents an integrated care model that is designed to promote coordination of […]

New Jersey Enacts Law to Expand Palliative Care

New Jersey has joined a growing list of states that are establishing laws to advance palliative care. Gov. Phil Murphy (D) has signed a bill to create a state advisory council on palliative care and quality of life. The new law also includes provisions for a hospice and palliative care access program to expand public […]

CMS Revises Immediate Jeopardy Citation Process

The U.S. Centers for Medicare & Medicaid Services (CMS) will now require its surveyors to report suspected crimes to local law enforcement, such as patient abuse, theft, sexual assault or other unlawful activity. The agency inserted new language into Appendix Q of its State Operations Manual that in addition to the law enforcement requirement lays […]