Home Health & Hospice Week

Focus on medication reimbursement continues.

A new Work Plan topic for the HHS Office of Inspector General may lead to you paying out more for patients’ drugs.

The OIG has added “Duplicate Drug Claims for Hospice Beneficiaries” as a new Work Plan item.

“Hospice providers are required to render all services necessary for the palliation and management of a beneficiary’s terminal illness and related conditions, including prescription drugs,” the OIG notes on its Work Plan website. “Medicare Part Apays providers a daily per diem amount for each individual who elects hospice coverage, and part of the per diem rate is designed to cover the cost of drugs related to the terminal illness. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to a hospice beneficiary’s terminal illness because the drugs are already included in the Part A hospice benefit.”

Previous OIG work has found “Medicare may have paid twice for prescription drugs for hospice beneficiaries, once under the Part A per diem rate and again under Part D,” the OIG says. “We will ... review the appropriateness of Part D drug claims for individuals who are receiving hospice benefits under Part A. We will also determine whether Part D continues to pay for prescription drugs that should have been covered under the per diem payments made to hospice organizations.”

The OIG expects to issue the report next year.