Category Archives: Hospice

CMS Proposed Rules for Immediate Jeopardy Situations for Providers Other than SNFs and NFs

In the April 5th Federal Register, the Center for Medicare and Medicaid Services (CMS) proposed new rules relating to immediate jeopardy situations for providers or suppliers that are not Skilled Nursing Facilities (SNFs) or Nursing Facilities (NFs). The proposed rules were published in April of 2013 in the Federal Register and generally apply to the oversight of accrediting organizations, but CMS also proposed a changed to the rule on providers and suppliers, other than SNFs and NFS, with deficiencies. Continue reading

OIG Issues Report Finding Inconsistencies in Medicare Billing for Hospice Inpatient Stays

On May 3, 2013, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections (OEI) issued a report (OEI-02-10-00490) entitled “Medicare Hospice:  Use of General Inpatient Care.”  The report found that while Medicare paid $1.1 billion for hospice general inpatient care (“GIP”) in 2011, there were unusual Medicare billing patterns for hospice inpatient stays, raising concerns about whether the stays were billed appropriately and whether the patients received the right level of care. Continue reading

Spring Cleaning – Dust Off Your Compliance Program Manual and Take Some Practical Steps to Reinvigorate Your Program.

Compliance program fatigue is nothing new. Over at least the last 15 years, health care organizations have jumped in head first, put together detailed manuals and taken the plunge. However, reimbursement cuts, quality initiatives, RACs, ZPICs, whistleblowers, physical plant renovations and simply significant industry challenges got in the way of sustaining an efficient and effective compliance effort. Health care organizations have also become desensitized to the barrage of compliance education, enforcement press releases, audits and reviews and other shock-value communications on the importance of regulatory compliance. In that vein, this very article may get lost in the shuffle, although, we hope it doesn’t.

An efficient and effective compliance effort with your organization is extremely important, if only as an insurance policy against government scrutiny. Additionally, the Patient Protection and Affordable Care Act of 2010, H.R. 3590 (“ACA”) includes requirements that CMS implement mandatory compliance program requirements for all providers and suppliers. In a distinct section of ACA, nursing home mandatory compliance programs were given a specific implementation timeline. Continue reading

OIG: OKs Volunteer Provided Care to Terminally Ill Patients Before Hospice Eligibility

The Department of Health and Human Services’ Office of Inspector General (“OIG”) recently issued advisory opinion 12-17 providing a favorable opinion on a not-for-profit hospital-based hospice’s proposed “community services” program.

The Community Services Program

Under the proposed program, the hospice planned to provide non-skilled services for free, to patients who were terminally ill but who did not qualify for the hospice benefit, because they either did not want to renounce curative treatment or because they had more than six months to live if the disease ran its normal course. The services the agency proposed to offer included companionship, visitation, transportation, running errands, food preparation, respite and assistance with reading and writing. The hospice specifically stated that it would not offer these services to patients that resided in nursing facilities. Continue reading

OIG: Hospice Activities in the 2013 Work Plan

On October 2, 2012, The U.S. Department of Health and Human Services Office of the Inspector General (“OIG”) released its Work Plan for 2013.  The OIG releases its work plan for each year in advance of the coming year. The work plan provides stakeholders in the health care industry with a broad overview of the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will review and evaluate during that fiscal year. This client alert is one in a series of alerts that will outline the OIG’s activities, as discussed in the 2013 Work Plan, for a specific industry sector – Hospice.

The OIG’s activities relating to Hospice for 2013 are focused on two issues that generally involved hospice –nursing home relationships. The following is a summary of each of the issues and what the OIG is focusing on. Continue reading

Top 10 Hospice Survey Deficiencies According to CMS at the NHPCO MLC 2012

Representatives of CMS’ Survey and Certification Group provided valuable insight into the top 10 survey citations/deficiencies for hospice providers at the National Hospice and Palliative Care Organization’s, 27th Annual Management and Leadership Conference last week. The informative session discussed survey deficiencies,  the implementation of quality measures as well as CMS’ efforts to reform the hospice reimbursement system. Understanding the top 10 survey deficiencies is an important part of planning overall regulatory compliance initiatives and day to day operations. The top ten citations relate broadly to the areas of care planning, supervision and training of employees, and the provision of certain counseling services. Continue reading

OIG’s Semi-Annual Report – What’s in it for Home Health and Hospice

Well, it took me a little longer to get to this than I planned, but the Thanksgiving holiday weekend slowed me down a bit.  As promised, here is a look at what the OIG semi-annual report has to say about home health and hospice.  The good news is that, unlike in some prior years, it does not say much. Continue reading