Justice Department’s Amedisys-Optum Inquiry Reflects Growing Antitrust Concerns

The U.S. Department of Justice (DOJ) will investigate potential antitrust violations in the UnitedHealth Group (NYSE: UNH) subsidiary Optum’s forthcoming acquisition of Amedisys, Inc. (NASDAQ: AMED). To date, neither Amedisys nor Optum have been accused of any wrongdoing. The DOJ performed a similar investigation when Optum acquired the health care technology company Change Healthcare earlier this […]

Hospice Industry Groups: CMS Must Reform Auditing Processes

Flaws exist in the U.S. Centers for Medicare & Medicaid Services’ (CMS) auditing processes, a coalition of industry organizations indicated in a letter to the agency. The organizations pointed to “fundamental, long-standing” problems pertaining to the audit focus areas, overpayment recovery and adjudication processes, as well as auditor consistency and education. The organizations included LeadingAge, […]

Where Hospice Compliance Meets Revenue Cycle Management

As regulatory agencies crack down on hospice spending, providers can benefit from recognizing the links between revenue cycle management and compliance. Regulatory activity is increasing on multiple fronts. For example, the U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG) has launched a nationwide audit of general inpatient hospice services […]

2024 Final Rule May Signal Changes in CMS’ Approach to Hospice Quality

Both innovative opportunities and cost challenges underly quality and health equity components of the U.S. Centers for Medicare & Medicaid Services’ (CMS) recently finalized hospice payment rule. The final rule included some key updates — and raised important questions — in the agency’s planned changes to quality measures and data collection, including those related to […]

CMS Unveils Dementia-Focused Payment Model with Interdisciplinary Care Approach

The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a new payment model demonstration geared toward dementia-related illnesses, which are becoming more prevalent among hospice patients. The Guiding an Improved Dementia Experience (GUIDE) Model is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and […]

Providers to Lawmakers: Hospice a ‘Huge Value to Medicare’

Rising regulatory scrutiny around length of stay may be having adverse impacts on health care costs and quality, hospice leaders said in a recent Congressional briefing. Fear of regulatory attention, audits or post-payment reviews related to longer stays could drive some hospice providers to discharge patients who can still benefit from their services, according to […]

What a Hospice Benefit Revamp Could Signal for M&A Trends

A restructuring of the Medicare Hospice Benefit could have impacts on merger and acquisition activity in the industry. Calls for changes to hospice eligibility and length of stay are growing louder among industry stakeholders. A main concern being voiced to the U.S. Centers for Medicare & Medicaid Services (CMS) is that the current six-month prognosis […]