Home Health & Hospice Week

The feds are taking hospice audits too far, industry representatives warn.

“We welcome and support the efforts [the Centers for Medicare & Medicaid Services] has initiated this year to address issues related to certification of what appear to be fraudulent hospice organizations,” say the American Academy of Hospice and Palliative Medicine, LeadingAge, the National Association for Home Care & Hospice, the National Hospice and Palliative Care Organization, and the National Partnership for Healthcare and Hospice Innovation in an Aug. 11 letter to Dara Corrigan, Deputy Administrator & Director of the CMS Center for Program Integrity.

But “we urge CMS and its audit contractors to shift the focus of current audit and recovery practices from obtaining large initial ‘overpayment’ recoveries to halting billing practices and patterns that clearly reflect failure to comply with fundamental requirements of the program,” the reps urge. “In so doing, we expect CMS to reduce the disproportionate audit burden that has been placed on hospice organizations that have a history of providing high-quality care,” they say.

Auditors should ease up on General Inpatient and long-stay claims, the letter exhorts. Instead, CMS should refocus auditors “on patterns and practices characteristic of providers that aim to minimize or avoid therapeutic care and supportive services that are required under the hospice benefit and fully reimbursed through the per diem payment,” they urge.

And hospice auditors are in serious need of education to become competent to review hospice claims, the letter maintains. See the consortium’s other suggestions to CMS in the five-page letter at https://leadingage.org/wp-content/uploads/2023/08/CPI-Hospice-Audits-Letter_Final.pdf.