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 […]

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 […]

Florida Expected to Take Hardest Hit in Hospice Staff Shortage

Ongoing workforce shortages in the hospice space are expected to worsen, with Florida taking the biggest hit due to the size of its population older than 65.  The number of hospice and palliative care physicians and members of other disciplines will drop precipitously during the next two decades, largely due to retirements and staff leaving […]

CMS Final Rule Could Lead to More Hospice Audits

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its annual final rule for hospice payments in Fiscal Year 2020, including a payment rebasing that raises rates 2.7% for three higher-acuity levels of care and cuts routine home care by a corresponding 2.7%. With regulatory scrutiny on the rise, some hospice providers are concerned […]

New Senate Caucus to Focus on Palliative Care

A bipartisan group of U.S. Senators has launched a new caucus to focus on legislation and policy that impacts palliative care. The legislators said they expect the Comprehensive Care Caucus to raise awareness of palliative care, promote utilization, improve care coordination, support caregivers and expand access to palliative care services. Founding members of the Comprehensive […]

EHR Rule Could Preclude Hospices from Primary Care First

Requirements for electronic health record (EHR) interoperability could preclude some hospices from participating in Medicare’s Primary Care First payment models. The U.S. Centers for Medicare & Medicaid Services (CMS) requires health care organizations that participate in the model to use certified EHR technology (CEHRT). CEHRT are IT products that comply with criteria established by CMS […]

House Ways & Means Starts Rural Health Task Force

The influential Ways and Means Committee within the U.S. House of Representatives has convened a Rural and Underserved Communities Health Task Force to consider health care delivery challenges in rural areas. The move comes as both chambers of Congress consider versions of legislation to expand hospice in rural locales.  The Rural Access to Hospice Act […]

Collaboration, Community Outreach Promote Hospice Growth

Collaboration with referral partners and community outreach have proven essential to hospice marketing efforts. As demand for hospice care grows, hospice providers in an increasingly competitive marketplace are working to bring a larger share of those patients under their wings. In addition to traditional methods such as territory management and improving call volume, many are […]

Accurate Cost Reporting Key for Hospice Reimbursement

As hospice providers await the U.S. Centers for Medicare & Medicaid Services (CMS) final rule that will indicate payment rates and regulatory requirements for 2020, experts are warning hospices to make sure that they are submitting accurate cost reports to the agency. The U.S. Centers for Medicare & Medicaid Services (CMS) in late April released […]