The U.S. Centers for Medicare & Medicaid Services (CMS) is making significant changes in 2024 to the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) payment model. The updates include the introduction of a new approach to payment designed to enhance care delivery and care coordination for patients in underserved communities, according […]
Hospices seeking to gauge the potential impact of new regulatory actions in the space can look to their counterparts in the home health field. The steps that the U.S. Centers for Medicare & Medicaid Services (CMS) has put forth to strengthen hospice program integrity mirror rules implemented in years past for home health providers, including […]
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 […]
The U.S. Centers for Medicare & Medicaid Services (CMS) is giving hospices a 3.1% increase to their per diem payments for 2024, according to a final rule published Friday. That will translate to a $780 million bump to hospice payments next year compared to Fiscal Year 2023, according to CMS. The finalized rule also raises […]
The U.S. Centers for Medicare & Medicaid Services (CMS) is conducting a small pilot program for post-payment reviews of hospice stays that exceed 90 days. The agency has contracted with Noridian Healthcare Solutions, LLC as its Supplemental Medical Review Contractor (SMRC). Noridian will perform the reviews and submit findings to CMS. “CMS internal data has […]
The health care space — including hospice — is increasingly shaped by numbers. During the past several years hospice providers have had to become experts in data management in order to remain competitive. Data has become invaluable to negotiations with referral and payer sources, as well as to regulatory compliance. But providers can also benefit […]
The U.S Centers for Medicare & Medicaid Services (CMS) is implementing a “period of enhanced oversight” for new hospices in California, Nevada, Arizona and Texas. A key component of the enhanced oversight includes a medical review of claims before a Medicare Administrative Contractor (MAC) will pay them. These actions follow reports of potentially unethical or […]
The Kidney Care Choices (KCC) model is among the reimbursement streams that is widening payment for palliative care services. It could also help improve utilization of serious illness and end-of-life care. Patients with chronic kidney disease can often receive fragmented care and expensive treatments. They also receive limited to no education about their health trajectories, […]
Increased regulatory and clinical oversight is needed to address common billing and documentation errors related to hospice general inpatient care, according to the U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG). Inaccurate billing was among the driving forces behind the OIG’s recently announced nationwide audit of general inpatient hospice […]
A new cancer-focused payment model demonstration from the Center for Medicare & Medicaid Innovation (CMMI) could create opportunities for palliative care providers. The goals of the Enhancing Oncology Model (EOM), which went live on July 1, are to improve quality and reduce the cost of cancer care with augmented care coordination. While documents on the […]
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