Home Health & Hospice Week
OIG Admits It Got Nearly Half The Claims Determinations Wrong In Compassus Audit
Plus: OIG pats itself on the back for hospital pay proration for early discharges to hospice. The trend of the OIG walking back its claims deemed improper in recent audits is stronger than ever in its latest audit report. Out of 100 claims submitted by Hospice Compassus Inc. of Payson, Arizona in 2014 through 2016, the HHS Office of Inspector General’s contracted auditor originally said 70 were improperly paid. After Compassus rebutted the findings, the OIG “revised our determinations for 32 claims,” it says in the report. “This resulted in 31 claims being allowable because 1 of the 32 claims remains unallowable for another reason.” Despite that admission, “we maintain that our findings and recommendations, as revised, are valid,” the OIG says. Compassus billed for ineligible patients, failed to document services provided, and upcoded for higher levels of care, the report alleges. Compassus doesn’t agree, it makes clear in the 19-page comment letter it filed for the report. “As OIG knows, just because a hospice patient does not pass away within six months of being certified as terminally ill does not mean that the patient did not qualify for hospice care or that the certifying physicians were wrong,” Morgan Lewis attorney Howard Young, Compassus’ counsel, says in the hospice’s letter. “CMS has long recognized that issues of life and death do not always follow an exact trajectory or timeline.” That’s especially true considering last year’s AseraCare decision about physician determinations of terminal illness (see HCW by AAPC, Vol. XXVIII, No. 33). “As the Eleventh Circuit … decided and clarified in the AseraCare opinion, under the Medicare hospice benefit the certifying physician’s certification of terminal illness (‘CTI’) must be given great weight,” Young emphasizes in the hospice’s response. “Based on the independent review conducted … OIG’s draft report contains numerous incorrect and inaccurate conclusions,” the letter says. Private equity firm Towerbrook Capital Health and health system Ascension Health combined forces to acquire hospice chain Compassus for $1.05 billion last year. OIG Celebrates Hospice Referral-Curbing Payment Mechanism Meanwhile, in its Semiannual Report to Congress issued Dec. 2, the OIG mostly gives hospices a pass for once. The watchdog agency does highlight its recommendation to prorate hospice DRG payments when patients transfer to hospice “early.” Congress took up the suggestion and “beginning in FY 2019, discharges to hospice care would also qualify as a postacute-care transfer and be subject to payment adjustments,” the report notes. The reimbursement policy change will save Medicare $500 million, the OIG estimates. Note: The 44-page Compassus audit is at www.oig.hhs.gov/oas/reports/region2/21601023.pdf. The Semiannual Report is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2020/2020-fall-sar.pdf.
Home Health & Hospice Week
- Compliance:
Home Health Improper Payment Rate Down To 9.3%
Insufficient documentation continues to plague HH claims. Not all the details are out about Medicare’s [...] - COVID-19:
Medicare Expands Hospital At Home Program As COVID Surge Swamps Hospitals
Make sure you understand the differences between the home health benefit and the hospital program. [...] - Fraud & Abuse:
CIA Violation Racks Up $1.3 Million in Penalties For HHA
OIG Semiannual Report works through the naughty list. ‘Tis the season for the OIG to [...] - Audits:
Miami HHA Owes $730,000, OIG Audit Charges
One-third of determinations reversed after rebuttal. A for-profit Miami home health agency is the latest [...] - Hospice:
OIG Admits It Got Nearly Half The Claims Determinations Wrong In Compassus Audit
Plus: OIG pats itself on the back for hospital pay proration for early discharges to [...] - Policy:
Home Care Aides Need First COVID Vaccinations Too, Home Care Groups Urge
Newly approved priority guidelines lack many details. All eyes were on a Centers for Disease [...] - Industry Notes:
Stark Law Reform Eases Some Self-Referral, Kickback Restrictions
Giving free tech to referral sources may be OK, one HHS example says. Home health [...] - Industry Notes:
Click On This For Medicare Advantage Carve-In Info
Medicare wants to make sure hospices are getting all the info about the new Medicare Advantage [...] - Industry Notes:
Beef Up HH Benefit, Study Urges
If insurers including Medicare really want to get the most bang for their buck out [...] - Industry Notes:
Sham Med Director Pay, Bonuses Feature In HH Fraud Settlement
A Sarasota, Florida home health agency and its top executives have agreed to pay $5.8 [...] - Industry Notes:
MACs Unite To Train On Addendum
If you’re struggling with the new hospice election addendum, the MACs are offering some help. [...]
