Home Health & Hospice Week

Your anxiety over possible kickback problems with nursing home arrangements might be well justified.

The HHS Office of Inspector General has for the second year chosen hospice-nursing home relationships as an area for scrutiny under its Work Plan. "We will review the nature and extent of hospice services that are provided to Medicare beneficiaries who reside in nursing facilities and assess the appropriateness of payments for these services," the OIG says under its "Medicare Hospice Care for Nursing Home Residents: Services and Appropriate Payments" topic in the plan.

"Medicare hospice spending doubled from $3.5 billion to $7 billion from 2001 to 2004, with the growth associated mostly with nursing home residents," the OIG points out. "A previous OIG review found that hospice beneficiaries in nursing facilities received nearly 46 percent fewer nursing and aid services than hospice beneficiaries residing at home."

Via medical review, "we will assess beneficiaries' plans of care and determine whether the services that they receive are consistent with their plans of care and whether payments are appropriate," the OIG says.

"They are very concerned about double payments for services in these situations," believes regulatory consultant Rebecca Friedman Zuber in Chicago.

The hospice-nursing home relationship gives rise to many misunderstandings, says Wash-ington, D.C.-based attorney Elizabeth Hogue.

Regulatory lack of clarity has led to these misunderstandings, believes attorney Marie Berlin-er with Lambeth & Berliner in Austin, Texas. And unfortunately the new hospice Conditions of Partic-ipation may clear up some areas, but raise new questions in other areas.

CMS hasn't yet published revisions to the nursing home CoPs that might help explain the rules either, Berliner adds. "The OIG's scrutiny of the frequency and level of services furnished to hospice patients who reside in nursing homes is a direct result of the inability of these providers to understand their roles, rights, and duties with respect to each other, as well as their obligations to work together to coordinate -- not limit -- care," Berliner tells Eli.

Tip: Hospices may find additional guidance in the commentary that the OIG included with the new CoPs, Hogue suggests. Study both the commentary and the final revisions to the COPs and revise your agreements with nursing homes consistent with the guidance provided, she counsels.

Other hot spots: The OIG will also examine physician billing for hospice beneficiaries and hospice utilization trends, the Work Plan says.