27 04, 2017

It’s Spring Cleaning Time. Is Your Hospice In Order?

By | April 27th, 2017|0 Comments

It’s that time of year again when the blooming landscape and longer days inspire a thoughtful inspection of how well our homes are in order. As we know, it is not uncommon during this process to stumble upon some areas of wear and tear that need fixing (e.g., broken gutters, missing shingles, clogged vents, the [...]

18 09, 2015

CMS Issues New Guidance Related to Redetermination and Reconsideration Claim Requests

By | September 18th, 2015|Comments Off on CMS Issues New Guidance Related to Redetermination and Reconsideration Claim Requests

In the midst of tremendous challenges facing the hospice industry, the Centers for Medicare and Medicaid Services (CMS) has issued guidance to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) that is likely to have a positive effect on hospice providers.  The guidance from CMS directs MAC and QIC reviewers to limit the redetermination and reconsideration review to the reason(s) the claim was initially denied for all post-payment reviews.

24 08, 2015

Returning Medicare and Medicaid Overpayments – Better Act Fast!

By | August 24th, 2015|Comments Off on Returning Medicare and Medicaid Overpayments – Better Act Fast!

Don’t shoot the messenger but compliance with Medicare and Medicaid rules just got tougher for hospice organizations.  In the first judicial opinion on when a Medicare or Medicaid “Overpayment” is “identified” for purposes of the Affordable Care Act’s (ACA) 60-Day Repayment Law, a New York federal court’s interpretation complicates the already difficult task providers face in having sufficient time to assess and quantify potential overpayments. 

25 06, 2015

The 2016 Hospice Wage Index Proposed Rule – Some Thoughts

By | June 25th, 2015|5 Comments

I have been thinking a lot about the FY 2016  Hospice Wage Index proposed rule (NPRM).  The more I have thought about it, however, the more complex it seems. I have needed to harken back to my salami methodology (described here) and try to break it down into manageable chunks. The only chunks I am focusing on are the ones having to do with payment reform (tiered reimbursement and the Service Intensity Add-On) and the "clarification" to include all diagnoses on claim forms (and the related - excuse the pun - virtually all / related and not related / prognosis vs diagnosis conundrums).