Home Health & Hospice Week

CMS downplays the increased burden.

Hospices have a little more time to get ready for a new requirement for physicians who certify patients for hospice, but it’s still going to make life harder.

“As part of CMS’ larger strategy to address hospice program integrity and quality of care … we are finalizing our proposal that … two categories of physicians must be enrolled in or opted out of Medicare for hospice services to be paid,” the Centers for Medicare & Medicaid Services says in a fact sheet for its final rule released July 28. “Requiring enrollment or opt-out will allow us to screen the physician to ensure they are qualified (e.g., licensed) to certify the terminal condition,” CMS explains.

The two categories of physicians required to be in enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) are:

1. the hospice medical director or the physician member of the hospice interdisciplinary group, and

2. the attending physician, if the beneficiary has one.

While CMS touts the requirement as a fraud prevention tool, the industry is skeptical.

“We … remain concerned that the requirement that hospice certifying physicians — including non-hospice attending physicians — will be required to be enrolled in Medicare as this may create some administrative challenges and potential delays in care,” Theresa Forster, VP for Hospice Policy for the National Association for Home Care & Hospice, says in a release.

Many commenters said the same, and then some. CMS disagreed with those who deemed this requirement unnecessary in light of other fraud-fighting measures the agency has been taking in the hospice space.

“There are multiple facets of the hospice arena that are concerning to us, and our hospice certifying proposal is directly aimed at ensuring that physicians who certify hospice services are adequately vetted and are confirmed to meet Medicare requirements,” CMS confirms in the rule.

And it pooh-poohs providers’ claims that the requirement may delay or otherwise install barriers to care. “We believe it is critical that hospice and attending certifying physicians be enrolled or opted-out,” CMS maintains. “We also believe the [CMS ordering and referring data file or ORDF] will enable hospices to expeditiously ascertain the physician’s enrollment/ opt-out status. This has been the general experience of other Medicare providers and suppliers (such as HHAs) who must verify the enrollment/opt-out status of physicians and practitioners,” the rule says.

CMS expects that only “2,173 certifying physicians would need to enroll or opt-out in order to certify hospice services,” it further says. “This is a very small number given the universe of over 2 million physicians nationwide, and most certifying physicians are already enrolled or opted-out,” the agency points out.

Beneficiaries also don’t have to designate an attending physician if they don’t want to, CMS points out. If the beneficiary doesn’t have an attending, “only the hospice certifying physician must sign the certification,” NAHC points out in its rule analysis.

“We are also confident that the vast preponderance of those who currently are not will choose to enroll or opt-out,” CMS adds in the rule. “This was our experience when we implemented the … DMEPOS, HHA, and imaging and clinical laboratory services requirement,” it says.

Bottom line: “We do not expect … physician shortages or postponements in care … to occur,” CMS concludes.

CMS does give way to commenters’ requests on one front, granting a seven-month delay to the requirement’s implementation date.

“A delay in implementation is warranted,” the rule allows. “An additional seven months is ample time to ensure certifying hospice and attending physicians meet all Medicare requirements, given the pressing program integrity concerns,” the agency says. And “we believe a May 1, 2024 implementation date strikes a sound balance between addressing our payment safeguard concerns while giving stakeholders time to prepare.”

What will happen: “Unenrolled and non-opted out hospice and attending physicians will have until April 30, 2024 to enroll or opt-out before the denial of hospice claims commences on May 1, 2024,” CMS spells out.