Hospice news update

Here are a few “quick hit” updates to stay informed about recent news affecting hospices.

Hospice audits

In late 2017, the Centers for Medicare and Medicaid Services (CMS) expanded its targeted probe and educate (TPE) audit program to include hospices. The TPE program focuses on providers with high improper payment rates and topics identified by the Medicare Administrative Contractors (MACs) through data analysis or billing patterns. During each “probe” round, the MAC reviews 20-40 claims and allows for one-on-one education to help the provider understand the cause of the errors. Any problems that fail to improve after three rounds of education sessions will be referred to CMS for next steps, which may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor or other action. Hospices should familiarize themselves with the TPE process to avoid inadvertent denials and other consequences.

Electronic filing of Hospice Notice of Election

Effective January 1, 2018, hospice providers are now able to electronically submit the Notice of Election (NOE) to Medicare. While this is a welcome change for hospice providers, CMS notes that Medicare systems limitations could affect the timeliness of NOEs submitted electronically. Medicare Transmittal 3866 details the revised NOE policy and sets forth guidelines for seeking an exception to the timely filing requirement when delays due to Medicare system constraints are outside the hospice’s control.

Physician assistants as attending physicians for hospice patients

On February 9, 2018, President Trump signed the Medicare Patient Access to Hospice Act into law, amending the Medicare statute to allow physician assistants to serve as the attending physician for hospice patients and perform other functions that are otherwise consistent with their scope of practice.

Pennsylvania hospice company and owner settle false claims lawsuits for $1.24 million

On February 8, 2018, the Department of Justice announced a $1.24 million settlement with Horizons Hospice, LLC (also known as 365 Hospice, LLC) and its owner/CEO to resolve allegations brought in two whistleblower lawsuits. The lawsuits alleged that Horizons submitted, or caused to be submitted, false claims to Medicare and Medicaid for patients who did not qualify for hospice, because they did not have life expectancy prognoses of less than six months, and that Horizons falsified records to support the false claims. 365 Hospice, LLC and the owner/CEO also entered into a five year corporate integrity agreement with the Office of Inspector General contemporaneously with the settlement.