False Claims Act (FCA) cases are a leading legal concern for hospice providers as the industry comes under ever-increasing regulatory scrutiny. Knowledge of the law will be the key for hospices to both prevent and build a defense against these kinds of claims, according to health care attorney Nick Jurkowitz of the Fenton Law Group. […]
Optima Healthcare Solutions
Hospices who understand and consider their Program for Evaluating Payment Patterns Electronic Reports (PEPPER) from their Medicare Administrative Contractor (MAC) can leverage that information to anticipate and correct payment issues that could lead to targeted probe and education (TPE) audits if left unaddressed. PEPPER contains provider-specific Medicare claims data that may indicate or create the […]
Documentation errors and omissions, live discharges and lengths of stay beyond six months are three red flags that could cause regulators to come knocking at a hospice’s door, according to a new report from Optima Healthcare Solutions. Hospice utilization among Medicare decedents rose to exceed 50% for the first time during 2018, according to the […]
In the midst of rising demand, costs, and sharpened regulatory scrutiny, many hospice providers are facing Medicare recertification review challenges that can seriously harm patients and families, as well as their own bottom lines. The U.S. Centers for Medicare & Medicaid Services (CMS) requires hospices to recertify patients who have survived beyond their initial estimated […]
Fewer than 50% of hospices indicated that they were ready for a federal audit or additional document request, according to a recent survey by Optima Health. As hospices come under increasing regulatory scrutiny, ensuring complete and accurate documentation is a growing concern. “The quality of a hospice provider’s documentation can determine the outcome of a […]