Home Health & Hospice Week

You may get even more scrutiny of your hospice claims, thanks to a Supplemental Medical Review Contractor topic. SMRC Strategic Health Solutions lists “Y3P0440 — Hospice” as a current topic as of March 15.

The HHS Office of Inspector General “issued a report in March 2016 saying a claims analysis found one-third of payments for General Inpatient Care in 2012 were improper, costing Medicare $268 million,” Strategic notes on its website.

“In response to the report, CMS agreed to determine an appropriate number of claims to review for GIP stays that may be billed inappropriately under Medicare coverage requirements.”

CMS has directed Strategic “to conduct post-payment review of claims for calendar year 2015 to identify claims for GIP care that may have been improperly paid under the Medicare Part A benefit,” the SMRC says. Strategic will be requesting documentation for GIP claims, including records supporting “a precipitating event … such as pain control or acute or chronic symptom management that cannot reasonably be provided in other settings”; “interventions tried … prior to GIP admission were unsuccessful”; pain and symptom control; and Plans of Care “covering the entire GIP stay … including the beneficiary’s response and collaboration with physician services, nursing services, medical social services, and counseling.”

See the project description and a link to a sample ADR letter at https://strategichs.com/smrc/project-y3p0440-hospice.